mitraclip case presentation -...

MitraClip Case Presentation

M. ChrissoherisDepartment of Transcatheter Heart

Valves

Tuesday, March 10, 15

Disclosures

- Proctoring activities for Abbott Vascular

I and the HYGEIA Hospital «Heart Team» have receivedresearch and/or travel grants and/or lecture fees from:- ABBOTT Vascular, Europe

HYGEIA Hospital Heart Team

Cardiologists: A Halapas, M Chrissoheris, K SpargiasCT Surgeons: N Boumboulis, S Skardoutsos, A Tsolakis, S PattakosAnesthesiologist: I Nikolaou, C NastoulisCongenital Cardiology: A TzifaVascular Surgeons: I Belos, S KaliafasRadiologists: C Mourmouris, F Laspas

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The patient• 61 year-old female with exertional

dyspnea• NYHA III-IV• Severe degenerative mitral regurgitation• Prolapse / flail anterior leaflet

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Vena Contracta Area

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The patient• 61 year-old female with exertional dyspnea• NYHA III-IV, normal coronaries• Severe degenerative mitral regurgitation– Prolapse / flail anterior leaflet

• Severe pulmonary hypertension (3/2014)– PA 120/60mmHg, PVR 13 Wood U.• No reversibility with Ventavis• Wedge 54mmHg

• Atrial fibrillation, morbid obesity (BMI 41kg/

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Heart Team Discussion• Logistic Euroscore 4.7%, STS 28%• Ideally a surgical MV repair patient but…• Inoperable due to critical pulmonary

hypertension, dilated / dysfunctional right ventricle and morbid obesity

• Referral for TMVR with MitraClip

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Baseline Final

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Baseline Final

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Baseline PV flow Final PV flow

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Post Procedure Course• Fluoroscopy time 30min12sec• Atrial fibrillation during procedure ! SR• ICU stay 24 hours• Discharge home on day 5 post procedure– Uneventful hospital stay

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Ischemic/Functional MR ! 77 year-old male, NYHA IV heart failure! Old inferolateral infarct (PCI stent LCx)! Ischemic mitral regurgitation (4+)! Moderate LV dilatation, EF ~40%! Severe pulmonary hypertension (sPAP 61mmHg)! Sarcoidosis on steroids, permanent pacemaker! Euroscore 21.4%, STS 5.4%

! Heart Team discussion

! Severe Functional Ischemic MR! On maximal medical Rx, not a CRT candidate! Surgical option to repair or replace the mitral valve! However no other strong surgical indication (no need for CABG)! Given increased risk " Consensus for transcatheter mitral valve

repair

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Ischemic CardiomyopathyPML tethering

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Ischemic CardiomyopathyPML tethering

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Ischemic CardiomyopathyPML tethering

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X-Plane with Color

Commisural LVOT-long axis

Case 1: The Typical Ischemic/Functional MR

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X-Plane with Color

Commisural LVOT-long axis

Case 1: The Typical Ischemic/Functional MR

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X-Plane with Color

Commisural LVOT-long axis

Case 1: The Typical Ischemic/Functional MR

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3D Full Volume with Color Doppler

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3D Full Volume with Color Doppler

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3D Full Volume with Color Doppler

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Mitral Valve Quantification: Tethering of both leaflets " Functional MR

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Mitral Valve Quantification: Tethering of both leaflets " Functional MR

Vena contracta area 0.9cm2 Tuesday, March 10, 15

3D–Focused Wide Sector (Zoom)

Anatomically oriented mitral valve (surgeon’s view)

Ao

LAA

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3D–Focused Wide Sector (Zoom)

Anatomically oriented mitral valve (surgeon’s view)

Ao

LAA

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Insertion of SLO 8F and Steerable Guide Catheter

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Insertion of SLO 8F and Steerable Guide Catheter

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Insertion of Steerable Guide

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Insertion of Steerable Guide

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Insertion of Steerable Guide

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Insertion of Steerable Guide

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MitraClip over Mitral Valve:Arms should be vertical to coaptation line

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MitraClip over Mitral Valve:Arms should be vertical to coaptation line

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MitraClip over Mitral Valve:Arms should be vertical to coaptation line

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MitraClip: Grasping in LVOT long axis view

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MitraClip: Grasping in LVOT long axis view

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First Clip in A2-P2 region

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First Clip in A2-P2 region

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Post 1st Clip Evaluation: MV area

Lateral Orifice 1.10cm2

Medial Orifice 2.10cm2

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Post 1st Clip Evaluation: MV area

Lateral Orifice 1.10cm2

Medial Orifice 2.10cm2

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Post 1st Clip Evaluation: MV area

Lateral Orifice 1.10cm2

Medial Orifice 2.10cm2

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After 1st M-Clip: Residual moderate MR (medially)

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After 1st M-Clip: Residual moderate MR (medially)

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After 1st M-Clip: Residual moderate MR (medially)

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2nd Clip over Mitral Valve: Assessment for perpendicularity

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2nd Clip over Mitral Valve: Assessment for perpendicularity

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2nd Clip over Mitral Valve: Assessment for perpendicularity

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2nd Clip positioning

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2nd Clip positioning

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Final Result

Baseline

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Final Result

Baseline

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Final Result

Baseline

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Final Evaluation:Mitral Valve Area 2.14cm2

Lateral Orifice 0.8cm2

Medial Orifice 1.34cm2

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Final Evaluation:Mitral Valve Area 2.14cm2

Lateral Orifice 0.8cm2

Medial Orifice 1.34cm2

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Final Evaluation:Mitral Valve Area 2.14cm2

Lateral Orifice 0.8cm2

Medial Orifice 1.34cm2

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