Transcatheter Mitral Valve Repair for Severe Mitral Regurgitation in Down’s Syndrome

J INVASIVE CARDIOL 2021;33(12):E1008.

Key words: congenital heart disease, Down’s syndrome, mitral valve regurgitation

A 34-year-old female with Down’s syndrome (DS) and a history of ventricular septal defect repairs (first operation at 4.5 months and repeat repair at 5 years) was referred for worsening dyspnea on exertion and orthopnea. Echocardiography demonstrated severe primary mitral regurgitation (MR) secondary to anterior leaflet prolapse and suspicious anterior mitral leaflet cleft. She underwent a left heart catheterization that demonstrated severe MR (Video Series). Given 2 prior sternotomies, we felt that she would likely benefit from an edge-to-edge (ETE) transcatheter mitral valve repair (TMVr) with the MitraClip system (Abbott Vascular).

Intraoperative transesophageal echocardiography (TEE) demonstrated anterior mitral leaflet cleft and severe MR. MR jet was mostly from A2 and P2 at the vicinity of the anterior cleft (Figure 1A, Video Series). We grasped the A2 and P2 segments as close as possible to the cleft. A MitraClip XTW G4 device was placed on the A2 and P2 immediately adjacent to the cleft (Video Series), resulting in reduction of severe MR to mild MR (Figures 1B and 1C and Video Series). The mean gradient across the mitral valve was 5 mm Hg at a heart rate of 62 beats/min post clip deployment. The patient was extubated and had an uneventful recovery. She was discharged on postprocedure day 1. At 3-week follow-up exam, the patient had complete resolution of her dyspnea and orthopnea with significant improvement in exercise capacity.

To the best of our knowledge, this is the first published description of ETE-TMVr in a patient with DS. This case experience suggests a potential role for ETE-TMVr in high-risk and complex congenital mitral pathologies. This includes symptomatic DS patients, particularly given the increasing life expectancy and reported high prevalence of regurgitant lesions in adults with trisomy 21.

• Feasibility of Transcatheter Mitral Valve Repair for Non-A2P2 Mitral Regurgitation
• Comparison of 26-mm Evolut and 23-mm Sapien 3 Valves in TAVR for Small Aortic Annulus
• Treating Mitral Valve Prolapse in Barlow’s Disease by Creation of a Medial MitraClip Bridge and a “New” Lateral Orifice: Rationale for MitraClip NTR Adoption
• Percutaneous Management of a Mechanical Complication Post Mitral Valve Surgery in a Child
• Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures
• Outcomes After Transcatheter Mitral Valve-in-Valve Replacement in Patients With Degenerated Bioprosthesis: A Single-Center Experience
• Sequential Use of Alcohol Septal Ablation and Electrosurgical Leaflet Resection Prior to Transcatheter Mitral Valve Replacement (TMVR)
• Evaluation of Effectiveness and Safety of Transcatheter Mitral Valve Repair Under Moderate Conscious Sedation