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. 2022 Aug 9;1(5):100431.
doi: 10.1016/j.jscai.2022.100431. eCollection 2022 Sep-Oct.

Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation due to Postinfarction Papillary Muscle Rupture

Chih-Wei Chang  1 , Steven Romero  1 , Matthew J Price  1
Affiliations

Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation due to Postinfarction Papillary Muscle Rupture

Chih-Wei Chang et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Early case reports have suggested that transcatheter edge-to-edge repair (TEER) with the MitraClip for the treatment of acute mitral regurgitation (MR) due to post-infarction papillary muscle rupture (PMR) may be an alternative for patients at prohibitive surgical risk. However, data on consecutive patients treated for this condition is lacking.

Methods: To define the procedural characteristics, medication use, hemodynamic parameters, and imaging data, we present 5 consecutive patients with acute MR from postinfarction PMR treated with TEER at Scripps Memorial Hospital La Jolla between June 2018 and November 2020.

Results: Successful reduction of MR and improved hemodynamics were achieved in all cases. Despite the procedural success, only 1 of the 5 patients survived until hospital discharge.

Conclusion: TEER may be an effective treatment for acute MR due to postinfarction PMR to reduce MR and improve hemodynamics. Survival to discharge was infrequent, suggesting that TEER may be appropriate only in selected patients.

Keywords: MitraClip; acute mitral regurgitation; papillary muscle rupture; transcatheter edge-to-edge repair.

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Figures

None
Postinfarction papillary muscle rupture with acute mitral regurgitation treated with transcatheter edge-to-edge repair.
Figure 1
Figure 1
Case 1 summary. (A) TEE: complete rupture of the anterolateral papillary muscle. (B) TEE: severe mitral regurgitation across A2-P2. (C) TEE: pulmonary vein systolic flow reversal. (D) Elevated left atrial V wave pressure of 62 mm Hg. (E) Transthoracic echocardiogram: postprocedural mild mitral regurgitation. (F) TEE: postprocedural normalized pulmonary vein systolic flow. (G) TEE: postprocedural multiplanar reconstruction. (H) Reduced left atrial V wave pressure of 20 mm Hg. TEE, transesophageal echocardiogram.
Figure 2
Figure 2
Case 2 summary. (A) Electrocardiogram: inferior ST-elevation myocardial infarction. (B) Coronary angiography: severe stenosis in the proximal and midright coronary arteries. (C) TEE: complete rupture of the posteromedial papillary muscle. (D) TEE: severe mitral regurgitation extending from A3-P3 to A2-P2. (E) Elevated left atrial V wave pressure of 52 mm Hg. (F) TEE: postprocedural mild mitral regurgitation. (G) TEE: postprocedural multiplanar reconstruction. (H) Reduced left atrial V wave pressure of 24 mm Hg. TEE, transesophageal echocardiogram.
Figure 3
Figure 3
Case 3 summary. (A) Electrocardiogram: inferior ST-elevation myocardial infarction. (B) Coronary angiography: subtotal occlusion of the midright coronary artery. (C) TEE: partial rupture of the posteromedial papillary muscle. (D) TEE: severe mitral regurgitation extending from A3-P3 to A2-P2. (E) Elevated left atrial V wave pressure of 34 mm Hg. (F) TEE: postprocedural trace mitral regurgitation. (G) TEE: postprocedural multiplanar reconstruction. (H) Reduced left atrial V wave pressure of 26 mm Hg. TEE, transesophageal echocardiogram.
Figure 4
Figure 4
Case 4 summary. (A) Electrocardiogram: inferior ST-elevation myocardial infarction. (B) TEE: partial rupture of the posteromedial papillary muscle. (C) TEE: severe mitral regurgitation. (D) TEE: pulmonary vein systolic flow reversal. (E) TEE: postprocedural trace mitral regurgitation. (F) TEE: postprocedural multiplanar reconstruction. (G) TEE: postprocedural normalized pulmonary vein systolic flow. TEE, transesophageal echocardiogram.
Figure 5
Figure 5
Case 5 summary. (A) Electrocardiogram: inferior-posterior, ST-elevation myocardial infarction. (B) Coronary angiography: complete occlusion of the proximal posterior descending artery and subtotal occlusion of the proximal posterolateral branch. (C) TEE: complete rupture of the posteromedial papillary muscle. (D) TEE: severe mitral regurgitation. (E) Elevated left atrial V wave pressure of 39 mm Hg. (F) TEE: postprocedural trace mitral regurgitation. (G) TEE: postprocedural multiplanar reconstruction. (H) Reduced left atrial V wave pressure of 15 mm Hg. TEE, transesophageal echocardiogram.
Central Illustration
Central Illustration
Postinfarction papillary muscle rupture with acute mitral regurgitation treated with transcatheteredge-to-edgerepair. (A) TEE: complete rupture of the posteromedial papillary muscle. (B) TEE: severe mitral regurgitation. (C) TEE: postprocedural trace mitral regurgitation. TEE, transesophageal echocardiogram.
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