Page 36 - Journal of Structural Heart Disease Volume 3, Issue 6

Case Report
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:192-198
DOI: https://doi.org/10.12945/j.jshd.2017.033.17
Received: July 25, 2017
Accepted: August 07, 2017 Published online: December 2017
Worsening of Functional Mitral Regurgitation
from Septal Dyssynchrony Induced by
Ventricular Pacing in Ebstein's Anomaly
Undergoing Percutaneous Mitral Valve Repair
Heajung L. Nguyen, MD1*, Marcella A. Calfon Press, MD, PhD2, Jamil A. Aboulhosn, MD3, Jeannette P. Lin, MD3, Peyman Benharash, MD4, Eric H. Yang, MD2
1 Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
3 Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
4 Division of Cardiothoracic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, California, USA
Abstract
A 67-year-old male with Ebstein’s anomaly and a du- al-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echo- cardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgi- cal risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient’s permanent pac- ing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and e ective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation. Copyright © 2017 Science International Corp.
Key Words
Mitral valve regurgitation • Dyssynchrony • Ventricular pacing • Percutaneous mitral valve repair • Ebstein's anomaly
Introduction
Percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip (Abbott, Menlo Park, CA, USA) system is a novel method of reducing severe symptomatic degenerative mitral valve regurgitation (MR) in high-risk or inoperable patients. Although randomized trials for its use in functional MR and end- stage heart failure are currently underway, there are a few reported cases of its use as a rescue therapy in critically ill patients with refractory cardiogenic shock [1, 2]. Here, we present a case of cardiogenic shock in a patient with Ebstein’s anomaly secondary to severe functional MR who underwent successful PMVR.
Case Presentation
A 67-year-old male with Ebstein’s anomaly, history of bioprosthetic tricuspid valve replacement for tri- cuspid regurgitation, and dual-chamber pacemaker due to sick sinus syndrome presented to the emer- gency department with progressive dyspnea on ex- ertion, abdominal distension, a 7-kg weight gain, and severe orthopnea. In the preceding 5 years, he had re-
* Corresponding Author:
Heajung L. Nguyen, MD
Department of Medicine
University of California at Los Angeles
757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095-7414, USA
Tel. +1 310 825 7375; Fax: +1 888 313 4815; E-Mail: HLnguyen@mednet.ucla.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
Accessible online at:
http://structuralheartdisease.org/