Acute Hemodynamic Changes Achieved With Successful MitraClip Procedure for Severe Mitral Regurgitation

J INVASIVE CARDIOL 2019;31(10):E301-E302.

Key words: LA pressure, mitral regurgitation, transcatheter mitral valve repair (TMVR)

An 85-year-old symptomatic (New York Heart Association class III) male with severe chronic mitral regurgitation (MR), left ventricular ejection fraction of 30%, permanent atrial fibrillation, and high surgical risk (EuroScore II, 13%) was qualified for a MitraClip (Abbott Vascular) procedure. Transesophageal echocardiography (TEE) quantified a regurgitant volume of 68 mL and effective regurgitant orifice of 40 mm² (Figure 1A). Right ventricular systolic pressure (RVSP) was 51 mm Hg, and both ventricles and atria were dilated. Prolapse of the medial scallop of the anterior leaflet was due to chordae tendineae rupture, whereas partial restriction of the posterior leaflet shortened the length of its mobile portion to 10 mm (Figure 1B). Mitral valve area measured three-dimensionally was 7.1 cm². The middle scallops of both leaflets were grasped with the single MitraClip device. TEE confirmed MR reduction to a mild degree with gradient of <5 mm Hg (Figure 1C). Left atrial (LA) pressure V wave immediately decreased from 39 mm Hg to 12 mm Hg, reflecting acute hemodynamic changes in passive filling of the LA (Figures 1E and 1F). Moreover, previously deep, negatively deflected Y descent normalized (physiologically reflecting the LA emptying into the left ventricle during ventricular diastole). A small deflection preceding the V wave was most likely a C wave (reflecting bulging of the mitral valve into the LA) previously hidden within the V wave. The morphology may resemble A wave (reflecting atrial contraction), but electrocardiography excluded sinus rhythm. Transthoracic echocardiography on day 2 revealed two small regurgitation jets with RVSP of 41 mm Hg (Figure 1D). Eventually, the patient was deemed New York Heart Association class I. At 1-month follow-up, RVSP was 29 mm Hg and mild residual MR was present.

From the ¹Medical University of Warsaw and ²Institute of Cardiology, Warsaw, Poland.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted July 8, 2019.

Address for correspondence: Michał Świerczewski, Institute of Cardiology, Department of Coronary and Structural Heart Diseases, Alpejska 42 Street, 04–628 Warsaw, Poland. Email: swierczewski.michal@yahoo.pl