Page 39 - Journal of Structural Heart Disease Volume 4, Issue 5

Case Report
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:234-239
DOI: https://doi.org/10.12945/j.jshd.2018.002.18
Received: January 08, 2018 Accepted: February 01, 2018 Published online: October 2018
Transcatheter Repair of Anterior Mitral Leaflet Perforation in a Patient with Mechanical Aortic Valve Using Antegrade and Retrograde Approaches: Case Report
Reda Abuelatta, MD1, Hesham Naeim, MD1,2, Ahmad AlAhmadi, MD1, Saleh Al Ghamdi, MD1, Osama Amoudi, MD1, Ibraheem AlHarbi, MD1, Abdelfatah Elasfar, MD1,3*
1 Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia 2 Cardiology Department, Alazhar University, Cairo, Egypt
3 Cardiology Department, Tanta University, Egypt
Abstract
Mitral leaflet perforations after surgical aortic valve replacement may be iatrogenic or due to endocarditis. We present a 20-year-old female who underwent sur- gical mechanical aortic valve replacement 8 months prior to this presentation for bicuspid severe aortic valve stenosis. She presented with acute decompen- sated heart failure with dyspnea and New York Heart Association (NYHA) functional class of III-IV. Transtho- racic (TTE) and transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) through an anterior mitral leaflet perforation. The pa- tient refused surgical repair and percutaneous closure of the perforation was decided and performed using both antegrade and retrograde approaches. In this re- port, we emphasize the details and challenges of the procedure.
Copyright © 2018 Science International Corp.
Key Words
Mitral leaflet perforation, Mechanical aortic valve, Catheter-based Mitral valve interventions
Introduction
Anterior mitral leaflet perforation complicating bi- cuspid aortic valve has been reported and are mostly iatrogenic or related to infective endocarditia [1]. For patients with clinical symptoms, surgical re-interven- tion is generally the accepted approach [2]; howev- er, reoperation after aortic valve replacement may be associated with an increased risk of mortality and morbidity. Very few sporadic cases of percutaneous closure of perforated anterior mitral leaflet have been reported [3-5]. We describe a case of successful per- cutaneous closure of an anterior mitral leaflet perfo- ration in a patient who previously had a mechanical aortic valve replacement. We present this case to em- phasize the role of double antegrade and retrograde approaches through both femoral arterial and ve- nous accesses and the challenges of the procedure.
Case Report
History
A 20-year-old female was diagnosed with bicuspid aortic valve (AV) and severe aortic stenosis (AS) com- plicated by infective endocarditis and mechanical AV
* Corresponding Author:
Abdelfatah Elasfar, MD
Adult Cardiology Department
Madinah Cardiac Center
Khalid Ibn Al Waleed Rd, Medina, 42351, Saudi Arabia
Tel.: +966 55 691 3210; Fax: +966 14 855 0481; E-Mail: elasfar_egy@hotmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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