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EVEREST II: Two MitraClip Procedure with Partial Detachment of Second Device

  • Ehrin J. Armstrong
  • Khung Keong Yeo
  • Jason Rogers
Chapter

Abstract

An important complication of the MitraClip procedure is single leaflet detachment. This case illustrates such a complication and demonstrates the echocardiographic and fluoroscopic images associated with it.

Keywords

Mitral regurgitation MitraClip Single leaflet detachment Surgery 

Supplementary material

Video 24.1

TTE: parasternal LAX w/o color. The parasternal long axis demonstrates mild prolapse of the posterior leaflet with some possible mild restriction of the anterior leaflet during diastole (AVI 4005 kb)

Video 24.2

TTE: parasternal LAX w/ color. There is an anteriorly directed jet of mitral regurgitation originating from the site of posterior leaflet prolapse (AVI 4455 kb)

Video 24.3

TTE: parasternal SAX. Short axis view shows that the MR has a wide but central jet (AVI 4165 kb)

Video 24.4

TTE: apical 4C view. The apical four-chamber view shows biatrial enlargement and left ventricular enlargement(A) (AVI 5082 kb)

Video 24.4

TTE: apical 4C view. The regurgitant jet originates centrally and is directed anteriorly(B) (AVI 3231 kb)

Video 24.5

TTE: apical 4C magnified. On magnified apical 4C views with a lower Nyquist limit, the large PISA can be appreciated, as well as the width of the mitral regurgitant jet at the level of the leaflets (AVI 3231 kb)

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Video 24.6 TEE: bicommissural w/ color. The bicommissural view shows a wide central jet (AVI 1340 kb)
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Video 24.7 TEE: 3C w/o color. On the three-chamber view, the posterior leaflet prolapse is apparent. There is also mild restriction of the anterior leaflet, suggesting a mixed functional/degenerative etiology (AVI 1774 kb)
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Video 24.8 TEE: 3C w/ color. The Doppler imaging shows the origin of the jet at the line of malcoaptation, and that the jet is directed anteriorly (AVI 1463 kb)
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Video 24.9 TEE: 4C w/o color. In the four-chamber view, the mild prolapse of P2 is apparent, with concomitant mild tenting of the anterior leaflet (AVI 1521 kb)
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Video 24.10 TEE: 4C w/ color. The Doppler regurgitant jet is directed anteriorly (AVI 1478 kb)
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Video 24.11 TEE: Bicom view. The first device is advanced across central portion of the valve (AVI 1733 kb)
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Video 24.12 TEE: 3C view. Positioning of the device is confirmed in the 3C view as it is advanced (AVI 1914 kb)
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Video 24.13 TEE: 3C view. The first device is deployed and grasps the anterior and posterior leaflets in a central location (AVI 1914 kb)
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Video 24.14 TEE: 3C view with Doppler. There is a persistent anteriorly directed jet of mitral regurgitation after deployment of the first device (AVI 1339 kb)
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Video 24.15 TEE: Bicom view with Doppler. The persistent MR can also be seen in the Bicom view, lateral to the first device (AVI 1743 kb)
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Video 24.16 TEE: Bicom view. A second device is advanced across the valve lateral to the first device (AVI 1820 kb)
Video 24.17

TEE: 3C view with Doppler. Post-deployment of two devices, there is minimal to no MR in the 3C view (AVI 1139 kb)

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Video 24.19 TTE: parasternal LAX w/ color. The parasternal long axis demonstrates recurrent MR with significant aliasing (AVI 1741 kb)
Video 24.20

TTE: apical 4C w/o color. In the A4C view during diastole, the devices appear well aligned and parallel (AVI 4966 kb)

Video 24.21

TTE: apical 4C w/o color. In systole, the orientation of the devices has changed, with the more lateral device flipping back into the left atrium. This is consistent with partial clip detachment (AVI 4907 kb)

Video 24.22

TTE: A4C with Doppler. On Doppler imaging, there is a large color jet of recurrent MR (AVI 4907 kb)

Video 24.23

Fluoro: diastole. In LAO cranial view during diastole, the devices appear well oriented in a stable position relative to the mitral valve leaflets (AVI 4907 kb)

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Video 24.24 Fluoro: systole. In LAO cranial view during systole, the lateral (second device) changes orientation, consistent with partial clip detachment (AVI 6934 kb)
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Video 24.25 TTE: parasternal LAX w/o color. After device explant and successful surgical mitral valve repair with partial leaflet resection and annular ring placement, there is good coaptation of the anterior and posterior leaflets. There is a postsurgical large pleural effusion (AVI 6934 kb)
Video 24.26

TTE: parasternal LAX w/ color. On Doppler imaging, there is only a trace jet of MR originating near the coaptation of A2 and P2 (AVI 5500 kb)

Video 24.27

TTE: apical 4C w/o color. A magnified apical 4C view shows the leaflet coaptation after surgical repair (AVI 2802 kb)

Video 24.28

TTE: apical 4C w/ color. There is trace MR by Doppler imaging (AVI 5043 kb)

Video 24.29

(AVI 3862 kb)

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Ehrin J. Armstrong
    • 1
  • Khung Keong Yeo
    • 2
    • 3
  • Jason Rogers
    • 3
  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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