scholarly journals MitraClip procedure with two MitraClips after indirect annuloplasty with the MONARC device

2014 ◽  
Vol 0 (0) ◽  
pp. 1-3
Author(s):  
Susanne Rutschow ◽  
Sebastian Jäger ◽  
Michael C. Gross
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Surgery ◽  
Functional Mitral Regurgitation ◽  
Anterior Leaflet ◽  
Mitral Valve Reconstruction ◽  
Heart Lung Machine ◽  
Valve Reconstruction ◽  
High Comorbidity ◽  
Lung Machine

Abstract Mitral regurgitation is associated with a worsened prognosis in dilated cardiomyopathy. First standard therapy consists of a mitral valve reconstruction through heart surgery including the heart–lung machine. In patients with high comorbidity, catheter-based techniques have been developed. In the Evolution I study, the MONARC system was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by >1 grade was documented in 50% of the patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip. It can be used for both functional and degenerative mitral regurgitations. We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0–1 after implanting a MONARC device four years ago with missing relevant reduction in mitral regurgitation. With this report, we illustrated the management of Mitraclip in a patient with an implanted MONARC device and technical difficulties through the bowing of the posterior annulus.

Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation

1994 ◽  
Vol 58 (3) ◽  
pp. 668-676 ◽  
Author(s):  
Cary W. Akins ◽  
Alan D. Hilgenberg ◽  
Mortimer J. Buckley ◽  
Gus J. Vlahakes ◽  
David F. Torchiana ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ischemic Mitral Regurgitation ◽  
Mitral Valve Reconstruction ◽  
Valve Reconstruction

Abstract 3387: The Effects of Restrictive Annuloplasty on Mitral Leaflet Coaptation and The Mechanism Regulating Functional Mitral Regurgitation: Simplified Echocardiographic Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yasuhiro Shudo ◽  
Kazuhiro Taniguchi ◽  
Koichi Toda ◽  
Hajime Matsue ◽  
Hiroki Hata ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Significant Negative Correlation ◽  
Functional Mitral Regurgitation ◽  
Anterior Leaflet ◽  
Mitral Leaflet ◽  
Diastolic Phase ◽  
Simplified Method ◽  
Leaflet Coaptation ◽  
Lateral Diameter

Objectives: The effects of restrictive annuloplasty on mitral leaflet coaptation in a clinical setting have not been fully elucidated. We developed a novel simplified method for assessing the actual degree of coaptation and investigated changes caused by its use. Based on our findings, we evaluated the direct effects of restrictive annuloplasty on mitral leaflet coaptation and the mechanism regulating mitral regurgitation. Methods and Results: We studied 23 patients (mean 60 years old) with functional mitral regurgitation (grade 3 to 4+) with congestive heart failure (LV ejection fraction 32±10%) due to idiopathic (n=8) or ischemic (n=15) who underwent mitral valve repair with restrictive annuloplasty and 20 normal control subjects. We measured the septal-lateral diameter, tenting height, tenting area, and coaptation length of the mitral valve in 4-chamber, 2-chamber, and long-axis views at mid-systole before and after surgery using transthoracic and transesophageal echocardiography procedures. Coaptation length was calculated with the following formula: Ad-Ac, where Ad equals the whole length of the anterior leaflet during the diastolic phase and Ac equals the length of the non-coaptation free portion of the anterior leaflet at mid-systole. Coaptation length index was defined as the ratio of coaptation length to septal-lateral diameter. Results: Tenting height and tenting area were significantly decreased, while coaptation length and coaptation length index were significantly increased (Table ). In multivariate analysis, coaptation length index showed a statistically significant negative correlation with degree of residual MR (r=0.77, p<0.0001) and was found to be the most reliable predictor of MR grade. Conclusion: Our novel simplified method provided quantitative and morphological descriptions of mitral leaflet coaptation, and can also provide important information for developing a surgical strategy for regulation of MR. Table

scholarly journals 1634 3D transoesofageal echocardiography in detection of anterior leaflet laceration during mitraclip implantation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Mariani ◽  
A G Cerillo ◽  
S Maffei ◽  
F Marchi ◽  
G Benedetti ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Color Doppler ◽  
Intraoperative Complications ◽  
The Body ◽  
Functional Mitral Regurgitation ◽  
Anterior Leaflet ◽  
Percutaneous Mitral Valve Repair ◽  
Annular Dilatation ◽  
Determinant Factor

Abstract Background MitraClip is a percutaneous way of treatment of mitral regurgitation. Recent trials demonstrate its value in modifying prognosis of patients with functional mitral regurgitation. During MitraClip implant imaging with 3D TEE is mandatory to guide the procedure and monitoring the results. Unfortunately, laceration of mitral leaflets is a well-described complication of Percutaneous Mitral valve repair by implantation of MitraClip. 3D TEE can be useful even to detect complication of the procedure and in particular leaflets lacerations. Here we describe a case where 3D TEE was capable to recognize and visualize a laceration in the anterior leaflet (AL) and we assume some mechanisms leading to this complication. Methods An 83 years old man with post-ischemic severe functional mitral regurgitation underwent to MitraClip implantation. The mitral valve shows a severe tenting and annulus was deformed and dilated. The procedure was performed under fluoroscopic and 3D TEE guidance (Philips iE33). Due to the large central regurgitation and large coaptation gap, we decide to implant MitraClip XTR, this is the larger device 5 mm longer. Results A single MitraClip XTR was implanted in the central scallop (A2-P2) in the region of the larger jet, after device positioning a further jet was detected in the region of implant and the original jet was unchanged. Using 3D color complete volume and X-plane reconstructions we recognize that the jet originates between the clip and the basal aspects of AL. Without color Doppler in 3D zoom and X plane reconstruction, a continuum solution was suspected in the body of AL but the shadow of the delivery system partially masked the region. After removal of the device, perforation of AL was clearly depicted also with 3D zoom without color Doppler. The patient was surgically treated and inspection confirmed the laceration and shows a worn thin AL. The laceration of AL can be caused by the tension on a thinned tissue carried out by the large device. The severe tethering and annular dilatation with a marked distance between anterior and posterior leaflet at the tip of the device may have been a determinant factor in the tear occurrence. Conclusion 3D TEE can clearly depict lacerations of leaflets during MitraClip implantation. Preoperative extensive analysis of valve geometry and inspection of leaflets searching for a thinned region can avoid intraoperative complications. The distance between leaflets at the expected tips of the MitraClip can be a predictive parameter of tension applied on the leaflets and of the risk of tearing. Abstract 1634 Figure. Image 1

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