Short Term Failure after Residual Intra Mitraclips Regurgitation Treated with Transcatheter Implantation of an Amplatzer Ventricular Septal Defect Device

<p>We here report the case of a patient with significant recurrent “intraclip” mitral regurgitation following the implant two Mitraclips for a functional mitral incontinence. An AMPLATZER Vascular Plug II deployed between the two clips with acute procedural success with post-procedural trans-esophageal echocardiography (TEE) showing a mild residual mitral regurgitation with trivial trans-valvuar gradients. Few months after the procedure, the patient was newly admitted for acute heart failure due to recurrent MR with a partial detachment of both clips and of the vascular plug forcing a surgical solution for the case.</p>

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Procedural and short-term outcomes of transcatheter closure of ventricular septal defect using lifetech multifunctional occluder: initial experience

Cardiology in the Young ◽

10.1017/s1047951120004229 ◽

2020 ◽

pp. 1-11

Author(s):

Judah D. Gozar ◽

Dexter E. D. Cheng ◽

Jose J. D. Del Rosario

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Tricuspid Regurgitation ◽

Septal Defect ◽

Transcatheter Closure ◽

Short Term ◽

Closure Rate ◽

Long Term Follow Up ◽

Procedural Success

Abstract The Lifetech Multifunctional occluder is a versatile device with an improved delivery and flexibility that reduces the risk of atrioventricular block. This is a retrospective, descriptive, pilot study done in 25 patients who underwent transcatheter closure of ventricular septal defect using Lifetech Multifunctional occluder from February 2017 to January 2018. The average age was 9.32 ± 7.20 years, with a range from 1 to 32 years. Procedural success was 100% with no case needing a change of device size. Closure rate on follow up was at 42% (10/24), 52% (12/23), and 81% (17/21) at 1 day, 1 month, and 6 months, respectively. At 6-month follow up, pre-procedure tricuspid regurgitation disappeared by 38%. However, the incidence of new onset tricuspid regurgitation to trace was 16% (2) and mild 8% (1). Pre-procedure mild aortic regurgitation remained the same status throughout the 6-month follow up. Closure of the defect did not improve or worsen the aortic regurgitation. Post-transcatheter closure of ventricular septal defect with mild infundibular hypertrophy, the 1-year-old patient had resolution of the infundibular hypertrophy after 6 months but our 9-year-old patient had persistence of the mild infundibular hypertrophy even after 6 months. One patient (4%) developed transient widened QRS complexes post-transcatheter closure that resolved after 1 month. In total, 92% of the patients had no periprocedural complications. While one patient each had an inadvertent urinary bladder puncture and device embolisation. Our retrospective review of the procedural and short-term outcomes of transcatheter closure of ventricular septal defect sizes 2–10 mm, using the Lifetech Multifunctional occluder, appears to be safe and effective. However, long-term follow up is warranted.

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An unrecognized combined congenital heart defect - Bicuspid aortic valve and ventricular septal defect as a cause of acute heart failure in adulthood

Cor et Vasa ◽

10.1016/j.crvasa.2017.10.002 ◽

2018 ◽

Vol 60 (5) ◽

pp. e512-e517 ◽

Cited By ~ 1

Author(s):

Kristýna Bayerová ◽

Gabriela Dostálová ◽

Zuzana Hlubocká ◽

Tomáš Paleček ◽

Jaroslav Hlubocký ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Ventricular Septal Defect ◽

Acute Heart Failure ◽

Bicuspid Aortic Valve ◽

Congenital Heart Defect ◽

Congenital Heart ◽

Septal Defect ◽

Heart Defect

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Preliminary results of the acute Heart Failure registry in the DELTA region of Egypt (DELTA-HF): a database and a quality initiative project

The Egyptian Heart Journal ◽

10.1186/s43044-019-0024-0 ◽

2019 ◽

Vol 71 (1) ◽

Author(s):

Abdelfatah Elasfar ◽

Sherif Shaheen ◽

Wafaa El-Sherbeny ◽

Hatem Elsokkary ◽

Suzan Elhefnawy ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Acute Heart Failure ◽

Valvular Heart Disease ◽

Beta Blockers ◽

Left Ventricular Ejection ◽

Systemic Hypertension ◽

Delta Region ◽

Device Therapy ◽

Short Term

Abstract Background Data about heart failure in Egypt is scarce. We aimed to describe the clinical characteristics and diagnostic and treatment options in patients with acute heart failure in the Delta region of Egypt and to explore the gap in the management in comparison to the international guidelines. Results DELTA-HF is a prospective observational cohort registry for all consecutive patients with acute heart failure (AHF) who were admitted to three tertiary care cardiac centers distributed in the Delta region of Egypt. All patients were recruited in the period from April 2017 to May 2018, during which, data were collected and short-term follow-up was done. A total of 220 patients (65.5% were males with a median age of 61.5 years and 50.9% had acute decompensation on top of chronic heart failure) was enrolled in our registry. The risk factors for heart failure included rheumatic valvular heart disease (10.9%), smoking (65.3%), hypertension (48.2%), diabetes mellitus (42.7%), and coronary artery disease (28.2%). Left ventricular ejection fraction (LVEF) was less than 40% in 62.6%. Etiologies of heart failure included ischemic heart disease (58.1%), valvular heart disease (16.3%), systemic hypertension (9.1%), and dilated non-ischemic cardiomyopathy (15.5%). Exacerbating factors included infections (28.1%), acute coronary syndromes (25.5%), non-compliance to HF medications (19.6%), and non-compliance to diet (23.2%) in acute decompensated heart failure (ADHF) patients. None of our patients had been offered heart failure device therapy and only 50% were put on beta-blockers upon discharge. In-hospital, 30 days and 90 days all-cause mortality were 18.2%, 20.7%, and 26% respectively. Conclusions There is a clear gap in the management of patients with acute heart failure in the Delta region of Egypt with confirmed under-utilization of heart failure device therapy and under-prescription of guideline-directed medical therapies particularly beta-blockers. The short-term mortality is high if compared with Western and other local registries. This could be attributed mainly to the low-resource health care system in this region and the lack of formal heart failure management programs.

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Use of MitraClip system for severe mitral regurgitation in cardiogenic shock: results from a multicentre observational Italian experience (the MITRA-SHOCK study)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2635 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Falasconi ◽

L Pannone ◽

F Melillo ◽

M Adamo ◽

F Ronco ◽

...

Keyword(s):

Mitral Regurgitation ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Therapeutic Option ◽

Strong Predictor ◽

Medical Emergency ◽

Short Term ◽

Italian Experience ◽

Procedural Success ◽

Mitraclip System

Abstract Background/Introduction Cardiogenic shock (CS) is a medical emergency and a frequent cause of death. CS can be complicated by mitral regurgitation (MR). The presence of at least moderate MR in the setting of shock was associated with about three-times higher odds of 1-year mortality. In the setting of refractory CS, percutaneous mitral valve repair (PMVR) can be a potential therapeutic option. Purpose The aim of the study was to evaluate the efficacy of percutaneous approach of severe MR in patients with CS assessing short-term clinical outcomes. Methods In this study we retrospectively included patients with CS and concomitant severe MR treated with Mitraclip system. We enrolled 28 patients from 5 Italian centers between 2012 and 2019. MitraClip implantation was performed according to each hospital standard care. CS was defined utilizing the Diagnostic Criteria of Cardiogenic Shock used in the SHOCK trial. Procedural success was defined as the presence of moderate or less MR after MitraClip implantation. Results All patients presented at least severe MR. All treated patients were at high surgical risk (STS mortality score 36.4±11.7%). Procedural success was obtained in 24 patients (86%). A mean of 1.71±0.76 clips per patients were implanted. In-hospital complications occurred in 13 patients (46%): 7 minor bleedings (25% of patients), 7 major bleedings (25%), 8 acute kidney injuries (28%). In-hospital mortality was 25% and the reported causes of death were cardiovascular in all patients. At Cox multivariate analysis procedural success was a strong predictor of in-hospital survival (HR 0.11, CI 95% 0.02–0.67, p=0.017). Conclusions PMVR with Mitraclip system in patients with CS and concomitant MR demonstrated high procedural success and acceptable safety. It can be considered a bailout option in this setting of patients with high short-term mortality. Larger prospective studies are needed. In-hospital mortality predictors Funding Acknowledgement Type of funding source: None

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