Bail-out edge-to-edge mitral repair for an acute single leaflet device attachment: a case report
Open Access
- 1 April 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal - Case Reports
- Vol. 5 (4), ytab147
- https://doi.org/10.1093/ehjcr/ytab147
Abstract
An acute single leaflet device attachment (SLDA) may occur during transcatheter mitral valve edge-to-edge repair (TMVr), if an inadequate grasping of the target leaflet and/or a leaflet injury are concomitant. The bail-out TMVr often fails due to the complex pathophysiology. We report a case of an acute SLDA after TMVr with the PASCAL Repair System for severe mitral regurgitation (MR) with mixed aetiology, i.e., a thin-appeared posterior leaflet and pseudo-prolapse of the anterior mitral leaflet due to mitral annular dilatation. An acute SLDA occurred 2 min after the deployment, with device detachment of the posterior leaflet. A bail-out TMVr with the MitraClip XTR system led to an optimal MR reduction with the PASCAL stabilized. Despite an adequate leaflet insertion of the 1st device achieved, the posterior leaflet was tear due to its fragile tissue characteristics. At discharge, echocardiography confirmed an optimal MR reduction to mild grade with both devices stabilized. The pathology of the mitral valve leaflet is essential to achieve successful TMVr procedure using edge-to-edge repair device. Since the mechanical stress to the target leaflet appears to vary according to the edge-to-edge repair devices, the leaflet tissue characteristics should be respected during device selection.Keywords
This publication has 9 references indexed in Scilit:
- Faculty Opinions recommendation of Transcatheter Valve Repair for Patients With Mitral Regurgitation: 30-Day Results of the CLASP Study.Published by H1 Connect ,2020
- Faculty Opinions recommendation of Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study.Published by H1 Connect ,2019
- Transcatheter Valve Repair for Patients With Mitral RegurgitationJACC: Cardiovascular Interventions, 2019
- Edge-to-Edge Mitral Valve Repair With Extended Clip ArmsJACC: Cardiovascular Interventions, 2019
- Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man studyThe Lancet, 2017
- Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk PatientsJACC: Cardiovascular Interventions, 2015
- Faculty Opinions recommendation of Percutaneous repair or surgery for mitral regurgitation.Published by H1 Connect ,2011
- Percutaneous Repair or Surgery for Mitral RegurgitationThe New England Journal of Medicine, 2011
- Percutaneous Mitral Repair With the MitraClip System: Safety and Midterm Durability in the Initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) CohortJournal of the American College of Cardiology, 2009