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Chiew K, Akhtar M, McGarvey M, Browne S, Vazir A, Heng EL, Smith R. Paradoxical Left-to-Right Device Embolization Complicating Transcatheter Mitral Valve Edge-to-Edge Repair. JACC Case Rep 2023; 5:101692. [PMID: 36523951 PMCID: PMC9745655 DOI: 10.1016/j.jaccas.2022.101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
We describe an unusual presentation of transcatheter mitral valve edge-to-edge repair device embolization into the left common femoral vein in a patient with primary degenerative mitral regurgitation. We hypothesize a possible mechanism for this phenomenon, factors that may increase the risk of this complication, and outline the patient's clinical course. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Kayla Chiew
- Address for correspondence: Dr Kayla Chiew, Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom.
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2
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Gaignard S, Babaliaros V, Perdoncin E, Gleason P, Xie J, Jokhadar M. Transcatheter Mitral Valve Repair in a Tricuspid Atresia Patient With Potts and Glenn Shunts. JACC Case Rep 2022; 4:1379-1383. [PMID: 36299650 PMCID: PMC9588587 DOI: 10.1016/j.jaccas.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Our patient was a 50-year-old woman with tricuspid atresia who had undergone palliation with a Potts shunt to the left pulmonary artery as an infant and a classic Glenn shunt to the right pulmonary artery as a young child. Under general anesthesia, she underwent transcatheter edge-to-edge repair of the mitral valve for severe symptomatic mitral regurgitation. (Level of Difficulty: Advanced.)
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Key Words
- ASD, atrial septal defect
- EROA, effective regurgitant orifice area
- LPA, left pulmonary artery
- LV, left ventricular
- MC, MitraClip
- MR, mitral regurgitation
- PEEP, positive end-expiratory pressure
- RPA, right pulmonary artery
- TEE, transesophageal echocardiography
- TEER, transcatheter edge-to-edge repair
- congenital heart disease
- cyanotic heart disease
- echocardiography
- mitral valve
- pulmonary circulation
- systolic heart failure
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Affiliation(s)
- Scott Gaignard
- Address for correspondence: Dr Scott Gaignard, Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Jr Drive Southeast, Atlanta, Georgia 30303, USA.
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3
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Rajotte K, Shalen E, Song HK, Golwala H, Cigarroa J, Burch G, Zahr F, Chadderdon SM. Severe MR With Prior Alfieri Stitch Treated With Transcatheter Edge-to-Edge Repair and a Vascular Plug. JACC Case Rep 2022; 4:1314-1318. [PMID: 36406907 PMCID: PMC9666753 DOI: 10.1016/j.jaccas.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
We present a case of a high-risk surgical patient with prior surgical Alfieri stitch and recurrent severe mitral regurgitation. In cases with suitable anatomy, mitral valve transcatheter edge-to-edge repair and vascular plug closure of a small regurgitant orifice can be used with excellent results. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | | | | | | | | | - Scott M. Chadderdon
- Address for correspondence: Dr Scott M. Chadderdon, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA.
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Liu X, Chen M, Han Y, Pu Z, Lin X, Feng Y, Xu K, Lam YY, Lim DS, Wang J. First-in-Human Study of the Novel Transcatheter Mitral Valve Repair System for Mitral Regurgitation. JACC Asia 2022; 2:390-394. [PMID: 36338402 PMCID: PMC9627920 DOI: 10.1016/j.jacasi.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 06/16/2023]
Abstract
Transcatheter mitral valve intervention treatment is a promising alternative therapy for patients with severe mitral regurgitation (MR). This is a multicenter, prospective, first-in-human study of transcatheter edge-to-edge repair (TEER) using a novel device for severe MR. Safety and efficacy were assessed immediately after the procedure and at 30-day follow-up. Twenty-three patients (age 70.0 ± 5.2 years) who were at high/prohibitive surgical risk underwent successful procedures without major periprocedural complications. All patients achieved residual MR ≤2+ at discharge, with 73.9% with 1+ residual MR. The left ventricular end-systolic diameter improved from 4.1 cm at baseline to 3.4 cm at 30-day follow-up. New York Heart Association functional class I/II after TEER was achieved in 87% of patients. This study demonstrated that TEER with the device was feasible and safe for the treatment of patients with severe MR. (Dragonfly-M Transcatheter Mitral Valve Repair System Early Feasibility Study; NCT04528576).
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre Medical Hong Kong, Hong Kong SAR, China
| | - D. Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
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5
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Sticchi A, Bartkowiak J, Brugger N, Weiss S, Windecker S, Praz F. Retrograde Retrieval of a Novel Large Mitral Clip After Embolization Into the Left Ventricle. JACC Case Rep 2021; 3:1561-1568. [PMID: 34729501 PMCID: PMC8543158 DOI: 10.1016/j.jaccas.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022]
Abstract
We describe the successful retrieval of a novel large mitral clip, which embolized in a patient with severe secondary mitral regurgitation and left ventricular dysfunction, dilated left ventricle, and severely tethered mitral valve leaflets in the setting of a challenging anatomy for transcatheter edge-to-edge repair. The description highlights planning, technical issues, and possible adverse events of this bailout procedure. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Alessandro Sticchi
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro per la Lotta Contro L'Infarto Foundation, Rome, Italy.,Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salome Weiss
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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6
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Shetty M, Lampert MB, Levisay J, Erwin JP, Ricciardi MJ. Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair: When Do You Close? JACC Case Rep 2021; 3:357-360. [PMID: 34317536 PMCID: PMC8311052 DOI: 10.1016/j.jaccas.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
Transcatheter edge-to-edge repair has revolutionized the management of mitral regurgitation in the high surgical-risk population. Iatrogenic atrial septal defects (iASDs) are an obligatory consequence of the procedure. The long-term sequelae of persistent iASDs are unknown but are believed to be dependent on their size, directionality of flow, and underlying hemodynamics. We discuss an uncommon scenario of a post–transcatheter edge-to-edge repair iASD that required immediate closure. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Mrinali Shetty
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark B Lampert
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Justin Levisay
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - John P Erwin
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark J Ricciardi
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA
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Luedike P, Riebisch M, Weymann A, Ruhparwar A, Rassaf T, Mahabadi AA. Feasibility of a Novel Transcatheter Valve Repair System to Treat Tricuspid Regurgitation in ccTGA. JACC Case Rep 2021; 3:893-896. [PMID: 34317649 PMCID: PMC8311276 DOI: 10.1016/j.jaccas.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022]
Abstract
Patients with congenitally corrected transposition of the great arteries (ccTGA) with significant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction have prohibitive surgical risk in adulthood. The PASCAL transcatheter valve repair system enables minimally invasive percutaneous tricuspid valve repair in the complex anatomy of patients with ccTGA. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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8
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McCauley BD, Herrmann HC, Chen T, Anwaruddin S. MitraClip for Secondary Mitral Regurgitation: Approach to the 2020 ACC/AHA Valvular Heart Disease Guidelines. JACC Case Rep 2020; 3:361-365. [PMID: 34317537 PMCID: PMC8311014 DOI: 10.1016/j.jaccas.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
We describe the case of an 83-year-old man with a history of ischemic cardiomyopathy and severe secondary mitral regurgitation. This case highlights the role of transcatheter edge-to-edge repair with the MitraClip in the management of symptomatic functional mitral regurgitation in a surgically unfavorable patient. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Brian D McCauley
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tiffany Chen
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saif Anwaruddin
- Division of Cardiology, St. Vincent's Hospital/Tenet Healthcare, Worcester, Massachusetts, USA
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