Page 31 - Journal of Structural Heart Disease Volume 5, Issue 3

Case Report
Journal of Structural Heart Disease, June 2019, Volume 5, Issue 3:70-74
DOI: https://doi.org/10.12945/j.jshd.2019.031.18
Received: September 19, 2018 Accepted: September 29, 2018 Published online: June 2019
Successful Mitral Clipping Procedure for Severe Mitral Regurgitation Following Ring Mitral Annuloplasty
Fayez Bokhari, MD, Mirvat Alasnag, MD*, Ashraf M. Anwar, MD, PhD Division of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
Abstract
Percutaneous mitral valve repair has become an alter- native to surgical MV repair in high-risk patients. It is primarily indicated in severe functional or degenera- tive MV regurgitation. The MitraClip system is a cathe- ter-based device that places a stitch at the edge of the anterior and posterior mitral leaflets. Here, we describe a case of recurrent pulmonary edema secondary to se- vere MV regurgitation after treatment with an annu- loplasty ring who was treated successfully using the MitraClip system.
Copyright © 2019 Science International Corp.
Key Words
Mitral Clip • Mitral Annuloplasty • High Risk
Introduction
Percutaneous mitral valve (MV) repair using the MitraClip (Abbott Laboratories) has become an alter- native to surgical MV repair in patients who are high- risk for surgery. The primary indication for this system is in severe functional or degenerative MV regurgita- tion. This system is catheter-based placing a stitch at the edge of the anterior and posterior mitral leaflets (usually the P2 scallop). Published studies, such as the EVEREST II Trial, and case reports have largely focused on those two categories of pathologies [1]. The utility of this percutaneous system has expanded recently
as other pathologies have been identified. Individuals who had undergone previous surgical repair is one such condition. Reports of recurrent MV regurgitation following surgical valvuloplasty range from 8-13% in published trials [2]. To date, only isolated case reports or small case series have been published [3, 4]. No randomized data of the use of MitraClip in patients who develop severe MV regurgitation after surgical repair (annuloplasty) have been conducted. Here, we describe a case of a patient who suffered from recur- rent pulmonary edema secondary to severe MV re- gurgitation after treatment with a ring annuloplasty.
Case Presentation
A 59 year-old female underwent mitral and tricus- pid valve surgical repair in 2002 for rheumatic valve disease, severe mitral regurgitation/mild mitral ste- nosis and severe tricuspid regurgitation. Her co-mor- bidities include obesity, bilateral knee osteoarthritis significantly limiting mobility, poorly controlled Di- abetes Mellitus Type II, hyperlipidemia, paroxysmal atrial fibrillation (on oral anticoagulation and rate control) and mild renal dysfunction. She did well for over 15 years. This last year she was admitted four times with recurrent pulmonary edema. She denied any chest pain or palpitations. A transthoracic echo- cardiogram revealed a severely impaired left ventric- ular systolic function, EF 20%, mitral annuloplasty
* Corresponding Author:
Mirvat Alasnag, MD
Division of Cardiology
King Fahd Armed Forces Hospital
P.O. Box: 9862, Jeddah 21159, Kingdom of Saudi Arabia
Tel.: +966 12 232 8888 (ext. 54200); Fax: +966 12 665 1868; E-Mail: mirvat@jeddacath.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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