Edge-to-edge mitral valve repair for acute mitral valve regurgitation due to papillary muscle rupture: a case report

Abstract

Background Papillary muscle (PM) rupture is a devastating mechanical complication of myocardial infarction that leads to cardiogenic shock and death. In this case, we report a patient with acute mitral regurgitation due to PM rupture that was treated successfully with MitraClip. Case summary An 85-year-old female patient with anterior ST-elevation myocardial infarction complicated with PM rupture and acute severe mitral regurgitation was admitted to our hospital. The patient’s surgical risk was considered to be prohibitively high, and was therefore, referred for transcatheter edge-to-edge repair with MitraClip. The procedure was successful, and the patient was discharged home in a stable condition. Discussion Acute mitral regurgitation due to PM rupture is a mechanical complication of myocardial infarction that should be treated early because of high mortality rates. This case highlights the role of MitraClip in acute mitral regurgitation and acute heart failure as an alternative to surgery method in high-risk patients.

Management of ST-Elevation Myocardial Infarction in High-Risk Settings

“…83 Few case reports suggest that MitraClip implantation can be a feasible alternative treatment option in high-risk patients with cardiogenic shock secondary to papillary muscle rupture. 84,85 Ventricular Septal Rupture Similar to papillary muscle rupture, the incidence of VSR has decreased from 0.5 to 2% in the prereperfusion era to 0.2% in the current era. 86,87 VSR usually manifests as a new, harsh, loud systolic murmur, with or without thrill, in the setting of rapid-onset hemodynamic deterioration with acute heart failure or cardiogenic shock.…”

Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions

“…Acute mitral regurgitation usually requires prompt surgical treatment while time to surgery can be bridged by stabilization with an intra-aortic balloon pump (IABP) or Impella in addition to medical therapy (36). Several case reports and registry data have reported emergent edge-to-edge reconstruction to be a feasible alternative in selected patients (37)(38)(39)(40).…”

Percutaneous mitral valve repair in acute mitral regurgitation: case report and review of the literature

“…Papillary muscle rupture is a severe, albeit rare, mechanical complication of acute myocardial infarction. This anatomic lesion is challenging given the large flail width and flail gap with frequent commissural localization requiring an extensive grasping with a concomitant high risk of chordal entanglement [19] . As a papillary muscle head may mimic an endocarditic mass, clinical context should guide the differential diagnosis [20] .…”

“…Real-world experience on percutaneous edge-to-edge repair of acute MR is uniquely derived from case reports and small-size registries, listed and synthetized in Table 2 [19,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] .…”

“…Even in low-risk patients undergoing isolated MV surgery with a low probability of surgical repair, MitraClip may be attempted, above all in high-volume centers. Eligibility for percutaneous edge-to-edge procedure requires only three conditions: possibility to grasp and approximate the leaflets, low risk of MV stenosis, and good-quality TEE imaging [19] .…”