Page 35 - Journal of Structural Heart Disease Volume 5, Issue 3

Case Report
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In this case, the etiology of her valve dysfunction is rheumatic valve disease which manifested with regurgitation more than stenosis. The MitraClip de- vice has rarely been used in this pathology. Its use has largely been for degenerative disease of the mi- tral valve. Results of the COAPT trial for functional mitral regurgitation were published this week. The study concluded that in patients with heart failure and symptomatic severe secondary mitral regurgita- tion on optimal guideline-directed medical therapy, transcatheter mitral repair resulted in lower hospital- izations and all cause mortality during the 24-month follow up period. The trial also met the prespecified safety endpoint [8].
Given her severe systolic dysfunction, she will re- quire intensive afterload reduction, heart rate control and close follow up. Cardiac Resynchronization ther- apy (CRT-D)is another treatment option. Data sup- ports its favorable effects on MV and left ventricular geometry with reduction of the prevalence of mod- erate and severe mitral regurgitation and heart fail-
References
1. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, et al. EVEREST II Inves- tigators. Percutaneous Repair or Surgery for Mitral Regurgitation. N Eng J Med. 2011;364:1395-1406. DOI: 10.1097/01. sa.0000410146.91957.d6
2. Suri RM, Clavel MA, Schaff HV, Michelena HI, Huebner M, Nishimura RA, et al. Effect of recurrent mitral regurgitation following degenerative mitral valve repair: long- term analysis of competing outcomes. JACC. 2016;67:488-498. DOI: 10.1016/j. jacc.2015.10.098
3. Kanda BS, Jay D, Farivar RS, Sorajja P. Leaf- let-to-annuloplasty ring clipping for severe mitral regurgitation. JACC: Cardiovascu- lar Interventions. 2016;9:e63-e64. DOI: 10.1016/j.jcin.2015.12.272
4. Simpsen M, Daon E, Wiley M, Mujica F. A case of successful mitraClip placement in a patient with severe mitral regurgitation after failed mitral valve ring annuloplasty. J Cardiothoracic and vascular anaethe- sia. 2018;32:1863–1865. DOI: 10.1053/j. jvca.2017.10.042
ure symptoms [9]. Since her ECG showed narrow QRS complexes, she is not a candidate for CRT-D.
Conclusion
This case report suggests MitraClip can be a safe and feasible percutaneous alternative treatment for individuals with a previous MV repair who are deemed too high risk for a redo surgical intervention. However, long term clinical outcomes, durability and safety need to be ascertained through large random- ized controlled trials.
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
Comment on this Article or Ask a Question
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Flameng W, Herijgers P, Bogaerts K. Recur- rence of mitral valve regurgitation after mitral valve repair in degenerative valve disease. Circulation. 2003;107:1609-1613. DOI: 10.1161/01.cir.0000058703.26715.9d Fuchs F, Hammerstingl C, Werner N, Grube E, Nickenig G. Catheter-based-edge-to- edge mitral valve repair after partial rup- ture of surgical annuloplasty Ring. JACC: Cardiovasc Interv. 2015;8:e263-e264. DOI: 10.1016/j.jcin.2015.08.023
Nishimura RA, Otto CM, Bonow RO, Car- abello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused update of the 2014 AHA/ACC guideline for the man- agement of patients with valvular heart disease: A Report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;70:252-289. DOI: 10.1016/j.jacc.2017.03.011
Stone G, Lindenfield J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018;9:1-12. DOI:
10.1056/NEJMoa1806640
9. Mihos CG, Yucel E, Capoulade R, Orencole MP, Upadhyay GA, Santana O, et al. Im- pact of cardiac resynchronization therapy on mitral valve apparatus geometry and clinical outcomes in patients with sec- ondary mitral regurgitation. Echocardiog- raphy. 2017;34:1561-1567. DOI: 10.1111/ echo.13690
Journal of Structural Heart Disease, June 2019
Volume 5, Issue 3:70-74
Cite this article as: Kurtz JD, Hlavacek AM, Baker GH. Correlation and Agree- ment of Steady-State Free Processed Imaging Cardiac Magnetic Resonance Imaging and Balloon Waist Diameter of the Right Ventricular Outflow Tract for Percutaneous Pulmonary Valve Replacement. Structural Heart Dis- ease. 2019;5(3):70-74. DOI: https://doi. org/10.12945/j.jshd.2019.028.18