mitraclip case presentation -...
TRANSCRIPT
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
Tuesday, March 10, 15
Final Evaluation:Mitral Valve Area 2.14cm2
Lateral Orifice 0.8cm2
Medial Orifice 1.34cm2
Tuesday, March 10, 15