Abstract
This is a case example of a patient with functional mitral regurgitation in Class III heart failure treated successfully with the MitraClip. This patient had significant surgical risk, and this case illustrates the step-by-step approach to such patients.
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TTE: parasternal LAX with and without color. There is significant tenting of the mitral leaflets and a posteriorly directed jet, consistent with a functional etiology and a restricted posterior leaflet secondary to the patient’s ischemic cardiomyopathy and left ventricular remodeling (MP4 3796 kb)
TTE: parasternal SAX with and without color. The regurgitant jet has a central origin, primarily along the coaptation line of the A2 and P2 scallops (MP4 4264 kb)
TTE: apical 4C view with and without color. In the magnified 4C view, the leaflet tenting is again apparent. The lateral wall of the left atrium entrains the regurgitant jet and may therefore possibly decrease the apparent Doppler severity of the MR (MP4 4521 kb)
TTE: apical 4C view. In this less magnified view, note the significant remodeling and spherical shape of the left ventricle (MP4 6732 kb)
TTE: apical 2C view. The regurgitant jet appears central in this view as well (MP4 3097 kb)
TEE: 4C without color. The 4C views confirms significant tenting of the anterior and posterior leaflets (MP4 5390 kb)
TEE: 4C with color. There is a significant jet of posterior MR resulting from tethering of the leaflets (MP4 3537 kb)
TEE: bicom with and without color. The bicommissural view confirms a central location of the regurgitant jet (MP4 3734 kb)
TEE: 3C with and without color. The tenting is again apparent in the 3C view. The posterior leaflet appears somewhat shorter in this view, but there is not any significant leaflet calcification or thickening that might interfere with leaflet grasping (MP4 3324 kb)
TEE: biplane. Biplane echocardiography is used to align the device and confirm a central location prior to grasping the leaflets (MP4 10998 kb)
TEE: bicom. After the first device is deployed, there is a persistent medial jet of MR (MP4 4184 kb)
TEE: biplane views. The second clip is deployed slightly medial to the first clip (MP4 12105 kb)
TEE: biplane Doppler views after second clip. Postdeployment, the two devices appear well seated and parallel to one another (MP4 8008 kb)
TEE: biplane views. There is 1+ MR after deployment of two devices. The majority of the apparent MR originates from turbulence at the location of the leaflet grasping (MP4 1328 kb)
TTE: parasternal LAX. The devices remain well oriented along the central portion of the mitral valve leaflets (MP4 4732 kb)
TTE: parasternal LAX with color. Doppler shows only 1+ MR (MP4 2746 kb)
TTE: 4C with and without color. In addition to the 1+ jet of MR on Doppler, note the persistent color flow across the interatrial septum, consistent with a small iatrogenic atrial septal defect (MP4 4780 kb)
TTE: 2C with color. In the 2C view, the 1+ jet of MR originates from a central location at the site of device coaptation (MP4 3650 kb)
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Armstrong, E.J., Rogers, J. (2013). EVEREST II Basic Functional Case Study. In: Feldman, T., Franzen, O., Low, R., Rogers, J., Yeo, K.K. (eds) Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair. Springer, London. https://doi.org/10.1007/978-1-4471-4294-2_12
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DOI: https://doi.org/10.1007/978-1-4471-4294-2_12
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