Transcatheter Mitral Valve Repair for Severe Mitral Regurgitation in Down’s Syndrome
Abstract
J INVASIVE CARDIOL 2021;33(12):E1008.
Key words: congenital heart disease, Down’s syndrome, mitral valve regurgitation
Case Presentation
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.
Affiliations and Disclosures
From the Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
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.
Manuscript accepted July 8, 2021.
The authors report patient consent for the images used herein.
Address for correspondence: Abdul Hakeem MD, Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, MEB 578B, New Brunswick, NJ, 08903. Email: ahakeem@gmail.com
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