Page 42 - Journal of Structural Heart Disease Volume 4, Issue 5

237 Case Report
Figure 3. Panels A and C. A cartoon showing the location of the anterior mitral leaflet perforation and its relation to the aortic valve, it was 5X5 mm in diameter and 8 mm away from the mitral valve closure line. Panels B and D. Same cartoon showing the ASD closure device in place and its relation to the MV closure line and also relation to aortic valve.
helpful through device deployment. The device was partially opened through the aortic valve then fully opened in the LVOT with good secured traction of the delivery system to close the second disc sandwiching the AML. The device showed no interference with the mitral valve closure mechanism and the anterior mitral leaflet moved freely. TEE showed no residual mitral incompetence; no diastolic gradient across the mitral valve and no LVOT systolic gradient (Figure 2A and 2B).
Follow up
The patient's clinical course was excellent as she had significant symptomatic improvement with NYHA class I and her follow-up echocardiography showed no residual MR, no diastolic mitral valve gra- dient and estimated systolic pulmonary artery pres- sure of 35 mmHg after 6 months following the proce- dure (Figure 2C and 2D).
Discussion
Mitral leaflet perforations are generally rare and mostly due to infective endocarditis [1, 6]. Other caus- es can be iatrogenic and would have occurred during surgery for the aortic valve, or due to autoimmune diseases like systemic lupus, erythematosus, or anti- phospholipid syndrome [7]. During aortic valve sur- gery, anterior mitral leaflet perforation can happen due to the fibrous continuity between the anterior mitral leaflet and the aortic valve [8]. Furthermore, the middle of the anterior mitral leaflet corresponds to the anatomical location of the commissure between the left and non-coronary sinuses of the aortic valve [8]. Because of this close anatomical proximity, either of the two valves may be injured during intervention for the other [8]. In a review of the complications in 475 cases after repair of aortic valve insufficiency done by Dyck et al. [9]; they reported two cases of perforation of the base of the anterior mitral leaflet. In
Abuelatta R. et al.
Transcatheter Repair of AML Perforation