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EVEREST II Basic Functional Case Study

  • Ehrin J. Armstrong
  • Jason RogersEmail author
Chapter
  • 3.6k Downloads

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.

Keywords

Mitral regurgitation Functional mitral regurgitation MitraClip High risk 

Supplementary material

Video 12.1

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 (AVI 3796 kb)

Video 12.2

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 (AVI 4264 kb)

Video 12.3

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 (AVI 4521 kb)

Video 12.4

TTE: apical 4C view. In this less magnified view, note the significant remodeling and spherical shape of the left ventricle (AVI 6732 kb)

Video 12.5

TTE: apical 2C view. The regurgitant jet appears central in this view as well (AVI 3097 kb)

Video 12.6

TEE: 4C without color. The 4C views confirms significant tenting of the anterior and posterior leaflets (AVI 5390 kb)

Video 12.7

TEE: 4C with color. There is a significant jet of posterior MR resulting from tethering of the leaflets (AVI 3537 kb)

Video 12.8

TEE: bicom with and without color. The bicommissural view confirms a central location of the regurgitant jet (AVI 3734 kb)

Video 12.9

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 (AVI 3324 kb)

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Video 12.10 TEE: biplane. Biplane echocardiography is used to align the device and confirm a central location prior to grasping the leaflets (AVI 10998 kb)
Video 12.11

TEE: bicom. After the first device is deployed, there is a persistent medial jet of MR (AVI 4184 kb)

Video 12.12

TEE: biplane views. The second clip is deployed slightly medial to the first clip (AVI 12105 kb)

Video 12.13

TEE: biplane Doppler views after second clip. Postdeployment, the two devices appear well seated and parallel to one another (AVI 8008 kb)

Video 12.14

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 (AVI 1328 kb)

Video 12.15

TTE: parasternal LAX. The devices remain well oriented along the central portion of the mitral valve leaflets (AVI 4732 kb)

Video 12.16

TTE: parasternal LAX with color. Doppler shows only 1+ MR (AVI 2746 kb)

Video 12.17

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 (AVI 4780 kb)

Video 12.18

TTE: 2C with color. In the 2C view, the 1+ jet of MR originates from a central location at the site of device coaptation (AVI 3650 kb)

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA
  2. 2.Department of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA

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