Case report: Transcatheter edge-to-edge repair with MitraClip for acute mitral regurgitation after myocardial infarction

Abstract

Introduction: Acute mitral regurgitation (MR) due to papillary muscle rupture (PMR) is a rare but lethal mechanical complication of acute myocardial infarction (MI). The treatment of patients with post-MI PMR, especially those with cardiogenic shock, presents great challenges due to the high surgical risk.

Patient concerns: We report an 80-year-old woman with a history of hypertension and diabetes mellitus, presented with chest pain. Despite an early percutaneous coronary intervention and transfer to the intensive care unit, her general condition and hemodynamic parameters continued to deteriorate rapidly.

Diagnosis: Evidenced by electrocardiogram, echocardiogram and coronary angiography, the patient was diagnosed with acute lateral and posterior ST-segment elevation MI, cardiogenic shock, PMR, severe MR, and pulmonary edema.

Interventions: The patient received percutaneous mitral valve repair with MitraClip (Abbott Vascular, Santa Clara, CA, USA) supported by extracorporeal membranous oxygenation and intra-aortic balloon pump.

Outcomes: The patient was discharged with relief of heart failure symptoms, reduced MR, and recovery of cardiac function, remaining in a stable condition in New York Heart Association class I after 15-month outpatient follow up.

Conclusion: Transcatheter edge-to-edge repair with MitraClip can serve as a viable alternative to surgery in reducing MR in post-MI PMR patients at high surgical risk.

Figure 1.

Echocardiography and fluoroscopic images of transcatheter edge-to-edge repair. (A and B) Transesophageal echocardiography (TEE): mid-esophageal long-axis view and color flow depicting severe eccentric mitral regurgitation (MR) due to prolapsed posterior leaflet. (C and D) 3D-TEE image and color flow demonstrating ruptured posteromedial papillary muscle and associated posterior (P2 scallop) leaflet flail with huge MR. (E and F) X-plane view demonstrating implantation of the first clip. (G and H) X-plane view with color flow demonstrating mild MR after implantation of 2 clips. (I and J) 3D-TEE image with surgical en face view of mitral valve depicting double orifice after implantation of 2 clips and mild MR. (K and L) Fluoroscopic image after implantation of 2 clips. 3D-TEE = three-dimensional transesophageal echocardiography.