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EVEREST II Delayed Second Clip for Early Recurrent MR

  • Ehrin J. Armstrong
  • Khung Keong Yeo
  • Jason RogersEmail author
Chapter

Abstract

This case sample highlights the use of a second MitraClip in a patient who had developed early recurrent mitral regurgitation, likely secondary to partial clip detachment.

Keywords

Mitral regurgitation Mitral valve prolapse MitraClip Partial clip detachment Recurrent mitral regurgitation 

Supplementary material

Video 17.1

TTE: parasternal LAX w/o color. The posterior leaflet has mild prolapse in systole (AVI 5701 kb)

Video 17.2

TTE: parasternal LAX w/ color. Color flow Doppler suggests significant MR (AVI 3903 kb)

Video 17.3

TTE: apical 4C. The posterior leaflet can be seen prolapsing in systole (a) (AVI 4753 kb)

Video 17.4

TTE: apical 2C view. There is posterior leaflet prolapsed (a) (AVI 5500 kb)

Video 17.5

TTE: apical 2C view. There is posterior leaflet prolapsed (a) (AVI 5500 kb)

Video 17.6

TTE: apical 2C view. There is posterior leaflet prolapsed with a central origin of the MR jet (b) (AVI 3407 kb)

Video 17.7

TEE: bicommissural w/o color. The P2 segment can be seen prolapsing in the center of the valve (AVI 4514 kb)

Video 17.8

TEE: bicommissural w color. There is significant MR with a central jet origin (AVI 4514 kb)

Video 17.9

TEE: 3C w/o color and w/ color. There is significant P2 prolapse with a small flail gap (left) and an anteriorly directed jet of MR (right) (AVI 4452 kb)

Video 17.10

TEE: 4C w/o color. There is P2 scallop prolapse with a small flail segment (AVI 6988 kb)

Video 17.11

TEE: 4C w/ color. The MR originates from the site of P2 prolapse (AVI 3312 kb)

Video 17.12

TEE: 3D reconstruction. In systole, 3D reconstruction shows prolapse of the P2 scallop (AVI 2062 kb)

Video 17.13

TEE: 3D reconstruction. There is mild flail in mid systole (AVI 2062 kb)

Video 17.14

TEE: Bicom view. The MitraClip device is oriented toward the center of the leaflets (AVI 7613 kb)

Video 17.15

TEE biplane views. The device is oriented to the center of the leaflets (AVI 15263 kb)

Video 17.16

Biplane TEE w/ Doppler. After deployment of one MitraClip, there is minimal Doppler MR on biplane views (left and right) (AVI 2196 kb)

Video 17.17

TEE: 3C clip deployed. Once positioning is confirmed, the device is deployed (AVI 7346 kb)

Video 17.18

TEE: 3C w/ Doppler. Post-deployment, there is a small jet of residual MR at the site of device deployment (AVI 2607 kb)

Video 17.19

TTE: parasternal LAX. At 1 month post-procedure, the device appears well seated along the midline of the mitral valve leaflets (AVI 4378 kb)

Video 17.20

TTE: parasternal LAX w/ color. In the intervening 1 month, severe MR has recurred, with a central jet origin (AVI 2821 kb)

Video 17.21

TTE: short axis w/o color. On the short axis view, the MitraClip is apparent in the center of the leaflet coaptation line, with roughly similar size medial and lateral orifices (AVI 4266 kb)

Video 17.22

TTE: short axis w/ color. The regurgitant jet appears to originate from the medial orifice (AVI 4072 kb)

Video 17.23

TTE: apical 4C. The device appears well seated along the middle of the mitral valve leaflets (AVI 3792 kb)

Video 17.24

TTE: apical 4C w/ color. The MR originated from near the device. The color flow Doppler is >2/3 of the left atrial area and reaches back to the pulmonary veins (AVI 3546 kb)

Video 17.25

TTE: apical 2C. In the two-chamber view, the device is central in location as well (AVI 4273 kb)

Video 17.26

TTE: apical 2C w/ color. Color Doppler again confirms a significant jet of MR (AVI 3336 kb)

Video 17.27

TEE: biplane views. In the three-chamber and bicommissural views, there is significant prolapse of the P2 scallop (AVI 14084 kb)

Video 17.28

TEE: biplane views w/ color. The regurgitant jet originates from the area of continued P2 prolapse and is directed anteriorly (AVI 1362 kb)

Video 17.29

TEE: 4C. In the four-chamber view, there is also some persistent flail of P2. Note that the image is left-right reversed (AVI 8513 kb)

Video 17.30

TEE: 4C w/ color. The jet of MR is directed anteriorly (AVI 2721 kb)

Video 17.31

TEE: biplane views. A second MitraClip device is directed at the A2-P2 interface in a central location (a, b) (AVI 12612 kb)

Video 17.32

TEE: Bicom view. Both devices can be seen in the bicommissural view (AVI 7507 kb)

Video 17.33

TEE: Bicom view with Doppler. Although there is some mild prolapse of P2, there is only minimal MR (AVI 2997 kb)

Video 17.34

TEE: biplane with Doppler. The residual MR is 1–2+ (AVI 1418 kb)

305590_1_En_17_MOESM35_ESM.avi (902 kb)
Video 17.35 TTE: parasternal long axis. The MitraClip devices can be oriented in the middle of the valve. Only one device can be seen in this parasternal long axis view (BMP 901 kb)
Video 17.36

TTE: parasternal long axis w/ Doppler. On Doppler imaging, there is 1–2+ persistent MR (AVI 2150 kb)

Video 17.37

(AVI 4442 kb)

Video 17.38

(AVI 1253 kb)

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Ehrin J. Armstrong
    • 1
  • Khung Keong Yeo
    • 2
    • 3
  • Jason Rogers
    • 3
    Email author
  1. 1.Division of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA
  2. 2.Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
  3. 3.Department of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA

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