Acute Hypotension After MitraClip Implantation due to Acute Left Ventricular Failure

The MitraClip is a percutaneously implanted device approved for the treatment of symptomatic organic mitral regurgitation in poor surgical candidates. Despite its proven efficacy and safety for mitral regurgitation treatment, the MitraClip may unmask the true afterload of the left ventricle by removing the low-pressure left atrial system and may cause acute left ventricular systolic failure (afterload mismatch). Rapid diagnosis and treatment of afterload mismatch is crucial to ensure optimal patient outcomes. The authors present a case of acute hemodynamic deterioration after MitraClip implantation in a patient with chronic severe left ventricular systolic dysfunction. Transesophageal echocardiography was pivotal for the rapid recognition of acute left ventricular failure and aided in the intraoperative decision-making process and therapy.

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Abstract 17145: Mitral Leaflet Growth and its Relationship with Functional Mitral Regurgitation in Non-ischemic Left Ventricular Systolic Dysfunction

Circulation ◽

10.1161/circ.130.suppl_2.17145 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yu Kang ◽

Xiao-Jing Chen ◽

Qing Zhang ◽

Xiao-Ling Sun ◽

Yu-Chen Chen ◽

...

Keyword(s):

Mitral Regurgitation ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Normal Subjects ◽

Left Ventricular ◽

Area Ratio ◽

Functional Mitral Regurgitation ◽

Mitral Leaflet ◽

Significant Difference ◽

Annular Dilation

Backgrounds: Recent studies evidenced growth of the mitral leaflet (ML) in patients with functional mitral regurgitation (FMR), casting doubt on the traditional understanding of FMR. The aim of this study was to explore whether growth of ML occurs in patients with non-ischemic left ventricular (LV) systolic dysfunction and to examine whether there was any relationship between the growth of ML and the development of FMR. Methods: Echocardiographic examination was performed in 3 groups of patients: patients with non-ischemic LV systolic dysfunction [LV ejection fraction (EF) <50%] and significant FMR (MR jet area ratio≥20%) (group1, n=40), patients with non-ischemic LV systolic dysfunction but no significant FMR (MR jet area ratio <20%) (group2, n=30), and normal subjects (group3, n=40). The lengths of the anterior (AML) and posterior (PML) mitral leaflets as well as the anterior-posterior mitral annular dimension (MAD) were measured to reflect the degree of ML growth and mitral annular dilation. The ratio of AML and PML to MAD (AML: MAD, PML: MAD) were calculated respectively to assess the adequacy of ML growth in the context of mitral annular dilation. Results: The AML, PML, and the MAD were all increased in patients with LV systolic dysfunction (group1 and group2) compared with normal subjects (group3). In patients with LV systolic dysfunction, both PML and MAD were further increased in group1 compared with group2. However, AML showed no significant difference between the 2 groups. As a result, PML:MAD showed no significant difference between group1 and group2, while AML:MAD was significantly decreased in group1 compared with group2 (Table 1). Conclusion: Mitral leaflet growth occurs in patients with non-ischemic LV systolic dysfunction. Insufficient growth of the anterior mitral leaflet relative to dilated mitral annulus is associated with the development of significant FMR.

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Cardiac resynchronization therapy following Carillon® annuloplasty device for symptomatic heart failure and functional mitral regurgitation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz224 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-5

Author(s):

Haqeel A Jamil ◽

Steven L Goldberg ◽

Klaus K Witte

Keyword(s):

Mitral Regurgitation ◽

Cardiac Resynchronization Therapy ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Functional Mitral Regurgitation ◽

Symptom Improvement ◽

Resynchronization Therapy ◽

Bundle Branch Block

Abstract Background Symptomatic patients with significant left ventricular systolic dysfunction (LVSD) require a tailored treatment approach. Both functional mitral regurgitation (FMR) and left bundle branch block (LBBB) can develop, contributing to clinical deterioration, and worse prognosis despite optimal medical therapy (OMT). Case summary We report the case of a symptomatic 60-year-old man on OMT with LVSD and significant FMR. His symptoms and FMR initially improved following transvenous mitral annuloplasty using the Carillon® Mitral Contour System® annuloplasty device. However, he subsequently developed LBBB with associated reduction in exercise capacity, for which he underwent cardiac resynchronization therapy, and ensuing symptom improvement and stabilization. Discussion Our case describes how targeted device interventions can be combined synergistically to optimize patient symptoms.

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