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Case Reports
. 2020 Aug;21(8):950-953.
doi: 10.1016/j.carrev.2020.05.030. Epub 2020 May 23.

Transcatheter Mitral Valve Repair with MitraClip for Severe Mitral Regurgitation and Cardiogenic Shock During the COVID-19 Pandemic

Kalyan R Chitturi  1 , Nadeen N Faza  2 , Stephen H Little  2 , Neal S Kleiman  2 , Michael J Reardon  3 , Sachin S Goel  4
Affiliations
Case Reports

Transcatheter Mitral Valve Repair with MitraClip for Severe Mitral Regurgitation and Cardiogenic Shock During the COVID-19 Pandemic

Kalyan R Chitturi et al. Cardiovasc Revasc Med. 2020 Aug.

Abstract

Transcatheter mitral valve repair with MitraClip (Abbott) is largely an elective procedure. The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care systems; in many cases elective interventions have been curtailed. Patients with severe mitral regurgitation (MR) and cardiogenic shock are high-risk surgical candidates and at risk of a poor outcome without intervention. The American College of Cardiology (ACC) and the Society of Coronary Angiography and Interventions (SCAI) recently proposed joint guidance on triage of structural heart disease (SHD) interventions during the COVID-19 pandemic. We present two illustrative cases of severe MR and cardiogenic shock that were successfully treated with MitraClip amidst the COVID-19 pandemic with good outcomes at short term follow-up.

Keywords: COVID-19; Cardiogenic shock; MitraClip; Mitral regurgitation.

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Figures

Fig. 1
Fig. 1
Case 1 Panel: Transcatheter mitral valve repair of severe mixed mitral regurgitation (MR). Transesophageal echocardiogram (TEE) reveals mitral annular dilation with tethering of the posterior leaflet, leading to malcoaptation (A), resulting in severe central MR (B). A 3D surgical view of the mitral valve illustrates the significant posterior leaflet tethering (C). Three MitraClip devices (1 NTR and 2 XTR) are deployed along the middle scallops of the anterior and posterior leaflets at A2-P2 (D) as visualized by 2D (E) and 3D imaging (F), respectively. The intervention results in a qualitative reduction in MR to mild with an acceptable diastolic gradient of 4 mmHg (G). The MitraClip devices (arrows) as visualized by fluoroscopy (H). Pre-procedure left atrial pressure (LAP) V wave (I) was 50 mmHg with reduction to 22 mmHg after the case. AV: aortic valve; IAS: interatrial septum; LAA: left atrial appendage; LA: left atrium; LV: left ventricle.
Fig. 2
Fig. 2
Case 2 Panel: Transcatheter mitral valve repair of severe degenerative mitral regurgitation (MR). Transesophageal echocardiogram (TEE) demonstrates a posterior flail leaflet with a flail gap of 16-mm (A) and segment width of 18-mm (B), resulting in severe anteriorly directed MR (C). A 3D surgical view of the mitral valve illustrates the flail P2/P3 segments (D). The posterior flail leaflet resulted in a reduced left ventricular outflow tract (LVOT) stroke volume of 18 cm3, as measured in deep transgastric views (E). Two MitraClip XTR devices (arrows) are deployed at A2-P2 and A3-P3 as visualized by 2D (F) and 3D imaging (G), respectively, to achieve a qualitative reduction in MR to mild. The final LVOT stroke volume increased to 65 cm3 (H). LAP V wave (I) improved from 28 mmHg at the start of the case to 12 mmHg (with transient increase to 45 mmHg upon initiation of an intra-aortic balloon pump for shock and positioning of the first clip). AV: aortic valve; IAS: interatrial septum; LAA: left atrial appendage; LA: left atrium; LV: left ventricle.
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References

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