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Stocker TJ, Nabauer M, Massberg S, Hagl C, Hausleiter J. Successful Transcatheter Closure of Iatrogenic Mitral Regurgitation After Aortic Valve Surgery. JACC Case Rep 2023; 28:102126. [PMID: 38204537 PMCID: PMC10774818 DOI: 10.1016/j.jaccas.2023.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/12/2024]
Abstract
We present 2 cases of significant mitral regurgitation secondary to pericardial patch avulsion from the anterior mitral valve leaflet after aortic valve replacement with aortic annulus enlargement. Both cases were successfully managed by transcatheter repair with off-label implantation of occluder devices.
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Affiliation(s)
- Thomas J. Stocker
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Nabauer
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Heart Surgery Clinic, LMU University Hospital, LMU Munich, Munich Germany
| | - Jörg Hausleiter
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Corominas L, Tauron M, Molina M, Tabilo JF, Leta R, Ginel A. Isolated congenital mitral leaflet perforation in a young adult: A case report. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Taha FA, Naeim H, Amoudi O, Alnozha F, Almutairi M, Abuelatta R. Transcatheter Mitral Valve Repair Technique in Specific Severe Mitral Regurgitation: Tips, Tricks, and Outcomes. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100043. [PMID: 37274546 PMCID: PMC10236813 DOI: 10.1016/j.shj.2022.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/06/2022] [Accepted: 04/14/2022] [Indexed: 06/06/2023]
Abstract
Background In specific patients with severe mitral regurgitation (MR), mitral valve (MV) pathology is unique and requires creative transcatheter repair techniques. This study aimed to evaluate the feasibility and safety of a new transcatheter MV repair technique, using occluder devices in symptomatic high-surgical-risk patients with severe MR, either due to MV leaflet (MVL) perforations or due to post-clips residual MR, and to report on their 6-month outcomes. Methods The study enrolled all high-risk patients with severe MR due to MVL perforations and post-clips residual MR who underwent transcatheter MV repair using occluder devices, from November 2016 to August 2019. Results The study enrolled 16 patients; 9 (56.25%) with MVL perforations and 7 (43.75%) with post-MitraClip (Abbott Laboratories, Abbott Park, Illinois) residual MR, with a mean age of 55.75 ± 16.69 years. Mean perforation/jet diameters were 5.75 ± 1.67 and 6.5 ± 1.93 mm, and the mean 3D-vena contracta area was 0.54 ± 0.14 cm2. Perforations were crossed retrograde (transaortic in 7 [43.75%] patients and transapical in 2 [12.5%] patients), and post-MitraClip devices residual jets were crossed antegrade (transvenous/transseptal). Six (37.5%) patients required arteriovenous loop formation for device deployment, that was antegrade transvenous/transseptal in 13 (81.25%) patients and retrograde transapical in 3 (18.75%) patients. Devices used were Amplatzer-ASO in 10 (62.5%) patients and Amplatzer-VP-II in 6 (37.5%) patients. Mean procedural and fluoroscopy times were 55.13 ± 16.24 and 16.25 ± 4.03 minutes, respectively. Patients passed successfully, without MV gradient change or device-related complications. Conclusions Transcatheter MV repair of MVL perforations/post-clips residual MR is a new, feasible, and safe technique for high-surgical-risk patients.
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Affiliation(s)
- Fatma Aboalsoud Taha
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hesham Naeim
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Osama Amoudi
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Fareed Alnozha
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Mansour Almutairi
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Reda Abuelatta
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
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Abstract
The 2 primary objectives of surgery in mitral valve infective endocarditis (IE) are total removal of the infected tissue and reconstruction of cardiac morphology, including repair or replacement of the affected valve. Single-institution series have suggested the feasibility and effectiveness of mitral valve repair (MVrep) over replacement in mitral IE in terms of in-hospital mortality and long-term event-free survival. This article reviews the history, details of the relevant repair techniques, and clinical results of MVrep for mitral IE.
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Affiliation(s)
- Yukikatsu Okada
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan.
| | - Takeo Nakai
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi Chuo-ku, Kobe 650-0047, Japan
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Chaturvedi H, Rao RS. Percutaneous closure of native anterior mitral leaflet perforation under three-dimensional transesophageal echocardiography guidance. Asian Cardiovasc Thorac Ann 2021; 29:819-821. [PMID: 33715391 DOI: 10.1177/02184923211001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are presenting a unique case of native anterior mitral leaflet (AML) perforation with severe mitral regurgitation leading to progressive dyspnea. Using real time three-dimensional transesophageal echocardiography, this case was accurately diagnosed and percutaneous closure has been done successfully with the device. Review of the literature showed successful transcatheter closure of AML perforation of only four cases, all post-operative status. So, it seems to be the first case of native AML perforation closure till date.
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Affiliation(s)
- Hemant Chaturvedi
- Department of Non-Invasive Cardiology, Eternal Hospital, Jaipur, India
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Schaff HV, Nguyen A. Contemporary techniques for mitral valve repair-the Mayo Clinic experience. Indian J Thorac Cardiovasc Surg 2020; 36:18-26. [PMID: 33061182 DOI: 10.1007/s12055-019-00801-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022] Open
Abstract
Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.
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Affiliation(s)
- Hartzell Vernon Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Naeim HA, Amoudi O, Mahmood A, Abuelatta R. Percutaneous closure of iatrogenic anterior mitral leaflet perforation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974453 PMCID: PMC7501909 DOI: 10.1093/ehjcr/ytaa142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022]
Abstract
Background Severe mitral regurgitation (MR) through the body of the anterior mitral leaflet (AML) is rare. The cause either iatrogenic during open-heart surgery or due to infective endocarditis. We present a case where a successful percutaneous closure of the AML perforation was an alternative to surgery. Case summary A 60-year-old male presented with shortness of breath (SOB) class III of 12 months duration. He underwent coronary artery bypass surgery with four grafts plus mitral valve (MV) repair 20 months ago. Transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE) revealed severe MR through the body of AML at A3. The percutaneous closure plan was to cross the AML perforation from the left ventricular side. The venacontracta of the perforation was 6 mm, an amplatzer septal occluder device 6 mm considered appropriate for closure of this hole. A snare catheter snared the wire and exteriorized creating arteriovenous loop. Amplatzer septal occluder 6 mm loaded to the delivery system till larger disc (left-sided) opened safely and freely below the MV apparatus. Once the left ventricular side disc opposed the ventricular surface of AML, the waist and left atrial disc gently released. The patient discharged in the next day. After 6 months, the patient had no more SOB, he returned to his daily activity. Follow-up TTE showed no MR, the closure device was stable in place. Discussion We added a successful case of transcatheter AML perforation to the literature. The role of TOE is crucial in diagnosis and procedure guidance.
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Affiliation(s)
- Hesham Abdo Naeim
- Madinah Cardiac Center, Adult Cardiology Department, Khaled Bin Waleed Street, PO 6167, Madinah, Saudi Arabia
| | - Osama Amoudi
- Madinah Cardiac Center, Adult Cardiology Department, Khaled Bin Waleed Street, PO 6167, Madinah, Saudi Arabia
| | - Abeer Mahmood
- Madinah Cardiac Center, Adult Cardiology Department, Khaled Bin Waleed Street, PO 6167, Madinah, Saudi Arabia
| | - Reda Abuelatta
- Madinah Cardiac Center, Adult Cardiology Department, Khaled Bin Waleed Street, PO 6167, Madinah, Saudi Arabia
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Eng MH, Frisoli TM, Greenbaum AB, Villablanca P, Wang DD, Lee J, O'Neill W. Percutaneous Approaches to the Treatment of Mitral Leaflet Perforation and to Residual Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair. Interv Cardiol Clin 2019; 8:383-391. [PMID: 31445722 DOI: 10.1016/j.iccl.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mitral valve disease becomes more prevalent as the population ages. As the number of percutaneous mitral valve interventions expands, obscure clinical scenarios may emerge and challenge conventional treatment algorithms. Strategies for dealing with complex repairs build on prior experience in mitral perivalvular leak repair. Cases using nitinol- and expanded polytetrafluoroethylene-based devices are used to treat mitral regurgitation in cases of focal mitral perforations and leaks between previously placed mitral valve edge-to-edge devices. This review discusses risks and benefits of performing such complex mitral repairs and informs clinicians of the strengths of weaknesses of different occluder devices in the mitral position.
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Affiliation(s)
- Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Tiberio M Frisoli
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Adam B Greenbaum
- Emory University Hospital, 550 Peachtree Street Northeast, Fl 6, Suite 600, Atlanta, GA 30308, USA
| | - Pedro Villablanca
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Dee Dee Wang
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - James Lee
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - William O'Neill
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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Patel P, Lee K, Aderinto A, Benz M, Tsompanidis A. Assessment and management of a 1.77-cm 2 mitral leaflet perforation as a subclinical cause of mitral regurgitation. Clin Case Rep 2018; 6:1961-1965. [PMID: 30349707 PMCID: PMC6186886 DOI: 10.1002/ccr3.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 11/27/2022] Open
Abstract
Anterior mitral valve perforations are commonly due to underlying infective endocarditis, which can lead to significant mitral valve insufficiency. In these cases, clinicians should have a high index of suspicion for infective endocarditis. After appropriate imaging, immediate surgical intervention is unequivocally the choice of management here for optimal patient outcomes.
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Affiliation(s)
- Paras Patel
- Rowan University School of Osteopathic MedicineStratfordNew Jersey
| | - Kevin Lee
- Rowan University School of Osteopathic MedicineStratfordNew Jersey
- Department of AnesthesiologyThe University of Toledo Medical CenterToledoOhio
| | | | - Michael Benz
- Department of Cardiology, CarePoint Health Christ HospitalJersey CityNew Jersey
| | - Antonios Tsompanidis
- Family Medicine Residency Program, CarePoint Health Christ HospitalJersey CityNew Jersey
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Hu YN, Wan S. Repair of infected mitral valves: what have we learned? Surg Today 2018; 48:899-908. [DOI: 10.1007/s00595-018-1637-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/18/2018] [Indexed: 01/10/2023]
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Wickliff EM, Weber CA, Wyler von Ballmoos MC, Dague HL, Novalija J, Almassi GH, Pagel PS. Mechanism of torrential regurgitation in mitral valve endocarditis: the usual chordal rupture-leaflet flail or another more dramatic structural defect? J Cardiothorac Vasc Anesth 2013; 28:854-6. [PMID: 24103714 DOI: 10.1053/j.jvca.2013.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Eliot M Wickliff
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Craig A Weber
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | | | - Heather L Dague
- Cardiothoracic Surgery Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jutta Novalija
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Toprak C, Kahveci G, Akpinar S, Tabakçi MM, Güler Y. Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis. Echocardiography 2013; 30:E231-5. [PMID: 23710761 DOI: 10.1111/echo.12259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We present a case of concomitant left ventricle (LV) to right atrial shunt (Gerbode-like defect) and anterior mitral leaflet perforation in a 32-year-old male after aortic valve replacement for infective endocarditis of bicuspid aortic valve. This case emphasises that intra-operative transesophageal echocardiography is a sine qua non for valvular surgical procedures.
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Affiliation(s)
- Cüneyt Toprak
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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de Marchena E, Badiye A, Robalino G, Junttila J, Atapattu S, Nakamura M, De Canniere D, Salerno T. Respective Prevalence of the Different Carpentier Classes of Mitral Regurgitation: A Stepping Stone for Future Therapeutic Research and Development. J Card Surg 2011; 26:385-92. [DOI: 10.1111/j.1540-8191.2011.01274.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hosseini MT, Chandrasekaran V. Transaortic mitral valve repair in double valve infective endocarditis. J Card Surg 2010; 25:651-3. [PMID: 20874818 DOI: 10.1111/j.1540-8191.2010.01127.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of a transaortic mitral valve repair in double valve infective endocarditis. Through a conventional oblique aortotomy, the aneurysmal part of the anterior leaflet of the mitral valve was excised, an artificial neo chorda was implanted, and the aortic valve was replaced.
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