scholarly journals MitraClip to Treat Severe Ischemic Mitral Regurgitation During Impella CP Support in a 70-Year-Old Woman

2020 ◽  
Vol 47 (4) ◽  
pp. 306-310
Author(s):  
Said Ashraf ◽  
Tomo Ando ◽  
Nimrod Blank ◽  
Ahmad Munir ◽  
Theodore Schreiber
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiogenic Shock ◽  
Mitral Valve Surgery ◽  
Circulatory Support ◽  
Drug Eluting Stent ◽  
Severe Mitral Regurgitation

Acute mitral regurgitation is a life-threatening complication of acute myocardial infarction. We present the case of a 70-year-old woman who had acute myocardial infarction complicated by severe mitral regurgitation and cardiogenic shock. Although current guidelines recommend mitral valve surgery for such patients, surgery often carries prohibitive risk of morbidity and mortality. Thus, in certain patients, percutaneous repair may be the only viable treatment option. In this case, we used a 3-step percutaneous approach involving coronary artery revascularization with a drug-eluting stent in the left circumflex coronary artery, mechanical circulatory support with an Impella CP pump for cardiogenic shock, and mitral valve repair with the MitraClip system for severe mitral regurgitation. After successful intervention, our patient regained hemodynamic stability and showed clinical improvement at one-month follow-up.

scholarly journals Isolated congenital cleft mitral valve leaflet: a rare cause of refractory cardiogenic shock complicating acute myocardial infarction

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Mubashir H. Bahrami ◽  
Hamza Z. Ansari ◽  
Maya Guglin ◽  
Georges Ephrem ◽  
George E. Revtyak
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Mitral Valve Leaflet ◽  
Refractory Cardiogenic Shock ◽  
Congenital Cleft ◽  
Rare Diagnosis

AbstractWe report a unique presentation of isolated congenital cleft mitral valve complicating cardiogenic shock from acute myocardial infarction. Isolated cleft mitral valve is an uncommon diagnosis that can have significant clinical implications, especially if not recognized in patients presenting to the catheterization lab with acute myocardial infarction and cardiogenic shock. A review of this rare diagnosis including the options and timing of therapeutic interventions, which can include MitraClip, is important for publication.The case is of a patient who presented with an anterior acute ST elevation myocardial infarction. Despite early coronary revascularization and conventional support, refractory cardiogenic shock ensued requiring mechanical circulatory support escalation to Veno-arterial extracorporeal membrane oxygenation. Subsequently, left ventriculography revealed a massively dilated left atrium and severe mitral regurgitation raising concerns for a mechanical mitral valve complication. The patient was taken to the operating room for possible mitral valve surgery, but a preoperative transesophageal echocardiogram revealed an isolated posterior cleft mitral valve. Since the patient had stabilized on mechanical circulatory support, emergent surgery was deferred. The patient successfully recovered during index hospitalization with mechanical circulatory support and discharged on guideline directed medical therapy.In conclusion, isolated cleft mitral valve is a rare diagnosis that can often be underrecognized without comprehensive 3-dimensional transesophageal echocardiography evaluation. If diagnosed early with significant regurgitation, surgical treatment results in good outcomes and preservation of LV systolic function. Percutaneous correction of a CMVL with MitraClip has been described and may offer an alternative approach for high risk surgical patients.

scholarly journals Emergent TandemHeart-ECMO for acute severe mitral regurgitation with cardiogenic shock and hypoxaemia: a case series

2020 ◽  
Vol 4 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Michael DiVita ◽  
Gautam K Visveswaran ◽  
Kasaiah Makam ◽  
Peyman Naji ◽  
Marc Cohen ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cardiogenic Shock ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Case Series ◽  
Mitral Valve Surgery ◽  
Circulatory Support ◽  
Severe Mitral Regurgitation ◽  
Open Heart ◽  
Intra Aortic Balloon Counterpulsation

Abstract Background  Acute severe mitral regurgitation (MR) associated with cardiogenic shock is a life-threatening emergency. Traditional teaching has focused on the need for emergent coronary angiography and/or intra-aortic balloon counterpulsation in preparation for emergent open-heart surgery for repair/replacement. Unfortunately, emergent open-heart surgery in patients with acute MR complicated by cardiogenic shock is associated with 25–46% perioperative mortality. New devices have provided additional options for stabilization prior to emergent surgery which facilitate improved outcomes. Case summary  We present two cases of acute severe MR resulting in cardiogenic shock and profound hypoxaemia. TandemHeart® mechanical circulatory support with an oxygenator spliced into the circuit, akin to veno-arterial extracorporeal membrane oxygenation (ECMO), facilitated haemodynamic stabilization and decongestion of the lungs facilitating successful bridge to mitral valve surgery. Successful discharge to home was achieved in both patients with good neurological outcomes and sustained long-term functional recovery at 18 and 14 months, respectively. Discussion Selective use of the TandemHeart®, with or without ECMO, facilitates management of the critically ill cardiogenic shock patient with acute severe MR.

scholarly journals Isolated Congenital Cleft Mitral Valve Leaflet: A Rare Cause of Refractory Cardiogenic Shock Complicating Acute Myocardial Infarction

2020 ◽  
Author(s):  
Mubashir Hamid Bahrami ◽  
Hamza Ansari ◽  
Maya Guglin ◽  
Georges Ephrem ◽  
George Revtyak
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Mitral Valve Leaflet ◽  
Refractory Cardiogenic Shock ◽  
Congenital Cleft ◽  
Rare Diagnosis

Abstract We report a unique presentation of isolated congenital cleft mitral valve complicating cardiogenic shock from acute myocardial infarction. Isolated cleft mitral valve is an uncommon diagnosis that can have significant clinical implications, especially if not recognized in patients presenting to the catheterization lab with acute myocardial infarction and cardiogenic shock. A review of this rare diagnosis including the options and timing of therapeutic interventions, which can include MitraClip, is important for publication.The case is of a patient who presented with an anterior acute ST elevation myocardial infarction. Despite early coronary revascularization and conventional support, refractory cardiogenic shock ensued requiring mechanical circulatory support escalation to Veno-arterial extracorporeal membrane oxygenation. Subsequently, left ventriculography revealed a massively dilated left atrium and severe mitral regurgitation raising concerns for a mechanical mitral valve complication. The patient was taken to the operating room for possible mitral valve surgery, but a preoperative transesophageal echocardiogram revealed an isolated posterior cleft mitral valve. Since the patient had stabilized on mechanical circulatory support, emergent surgery was deferred. The patient successfully recovered during index hospitalization with mechanical circulatory support and discharged on guideline directed medical therapy. In conclusion, isolated cleft mitral valve is a rare diagnosis that can often be underrecognized without comprehensive 3-dimensional transesophageal echocardiography evaluation. If diagnosed early with significant regurgitation, surgical treatment results in good outcomes and preservation of LV systolic function. Percutaneous correction of a CMVL with MitraClip has been described and may offer an alternative approach for high risk surgical patients.

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