Percutaneous mitral valve edge-to-edge repair with MitraClip (Abbott, Abbott Park, Illinois) has emerged as an effective and safe treatment for symptomatic mitral regurgitation in suitable patients. The safety of the MitraClip procedure is well established, and the rate of major complications is 4.35%. We present 4 cases of mitral regurgitation in patients who had complications following the MitraClip procedure. ( Level of Difficulty: Intermediate. )
We are summarizing the recommendations for the use of Echocardiography in patients during COVID-19 pandemic. The patient risk for COVID-19 should be assessed according to the Saudi CDC guidelines. Echocardiography should only be performed of considered appropriate and will likely alter the clinical decision. In COVID-19 suspected/ confirmed patients, echocardiography study should be performed bedside and in infection control approved area with airborne precaution. Limited focused imaging is recommended to minimize contact time. A dedicated machine for COVID-19 suspected/confirmed cases is recommended. Transesophageal echocardiography is considered an aerosol generating procedure; therefore, an alternative modality should be strongly considered. In COVID-19 suspected/ confirmed patients, a transesophageal echocardiogram should be done only under strict airborne precaution. In low risk patient for COVID-19, Transesophageal echocardiography should be done with a minimum of droplet precaution, however; N95 respirator is preferred to surgical mask in this situation.
rupture of a papillary muscle is an uncommon but often fatal complication of acute myocardial infarction (MI) which is responsible for approximately 5% of death after MI (1,2). the characteristics of the underlying coronary disease will define the clinical presentation and prognosis; the mortality could be as high as 80% during the first week of post MI. The rupture of the posteromedial papillary muscle is most common, seen in about 75% of cases. the posteromedial muscle has a single blood supply from the posterior descending branch of a dominant right coronary artery, and is associated with inferior wall infarctions. the rupture of the anterolateral muscle is less common, occurring in 25% of cases, as it has dual blood supplies: from the first obtuse marginal, originating from the left circumflex; and from the first diagonal branch, originating from the left anterior descending. the rupture of the latter is seen with anterior or postero-lateral MI 3,4 .A 62-year-old sudanese male presented to the emergency room with chest pain for 6 hours. He had mild concomitant shortness of breath. there was no history of orthopnea or paroxysmal nocturnal dyspnoea. past medical history was remarkable for hypertension, non-compliant with medications and he was an active smoker. there was no family history of coronary artery disease. He had similar chest pain 5 days prior to presentation but he did not seek medical advice due to eligibility issues. on physical examination the patient was conscious and oriented, with a blood pressure of 150/80 mmHg, heart rate 100 bpm and regular, and respiratory rate 20/min. Neck veins were not distended and he had no ankle edema. on examination of the cardiovascular system he had a regular s1 and s2. No murmur was heard. He had normal vesicular breathing in both lungs. Initial eKg showed st elevation and the inferior leads (II, III and aVF) with ST depression at V2, V3 and V4 (fig 1). The chest radiography showed normal size of the heart with normal lung parenchyma. patient was taken to the cath lab within 40 minutes at acute steMI. Coronary angiogram revealed: dominant right coronary artery which was totally occluded at the mid segment. Left circumflex artery with 60 % disease at the proximal segment, with small caliber first obtuse marginal (OM1) and second obtuse marginal (oM2), both sub-totally occluded at the proximal end. underwent primary pCI (percutaneous intervention) to the right coronary artery (fig 2).
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