Killing two birds with one stone—MitraClip for flail P2 and systolic anterior motion of mitral valve: a case report

Wong, Ningyan; Hamid, Nadira; Tang, Hak Chiaw; Yeo, Khung Keong

doi:10.1093/ehjcr/yty146

Cited by 6 publications

(5 citation statements)

References 15 publications

(12 reference statements)

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“…While a higher prevalence of chordal rupture (5.4%) has been reported in a small surgical series (12), a larger cohort of HCM patients showed that chordal rupture is a rare event in HCM (1%) (11). From a literature search, we found 26 cases of HCM with ruptured chordae tendineae (Table 1) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Etiopathogenesismentioning

confidence: 85%

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana¹,

Selimi²,

Gizzi³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAbnormalities of the mitral valve (MV) apparatus are typical features of hypertrophic cardiomyopathy (HCM). These abnormalities include leaflet elongation, thick leaflets, displacement of papillary muscle, and systolic anterior motion (SAM) of the MV anterior leaflet. Mitral valve chordal rupture associated with HCM is a rare but serious issue capable of change the clinical apparence and the prognosis of the patient.Case summaryA 57-year-old lady with a history of diabetes, dyslipidemia, and a previous single episode of atrial fibrillation (treated with pharmacological cardioversion), presented to the Emergency Department for worsening dyspnea (New York Heart Association Classification class IV). A trans-thoracic echocardiogram (TTE) showed a significant, septal, and asymmetric left ventricular hypertrophy (basal anteroseptal wall diastolic thickness of 19 mm) with normal left ventricle systolic function. A SAM of AML was evident together with a left ventricular outflow tract gradient of 56 mmHg at rest, rising to 136 mmHg during the Valsalva maneuver. In addition, there was evidence of moderate to severe mitral regurgitation (MR) with an anteriorly directed jet, not very typical of MR related to SAM. A 2D-3D trans-esophageal echocardiogram (2D-3D TEE) revealed a combined MR mechanism based on PML degenerative prolapse with P2-flail from ruptured chordae with related eccentric anteriorly directed regurgitant jet, together with a second regurgitant posteriorly directed jet, related to SAM of AML. The patient underwent MV repair together with septal myectomy, with a good final outcome.ConclusionPre-operative echocardiography (both TTE and 2D-3D TEE) is an essential tool in order to detect different MV abnormalities in patients with HCM. These types of patients should never be treated by septal reduction alone. Surgical MV repair or replacement, together with septal myectomy, may be the preferred approach.

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Section: Etiopathogenesismentioning

confidence: 85%

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana¹,

Selimi²,

Gizzi³

et al. 2022

Front. Cardiovasc. Med.

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“…10,11 It has an association with hypertrophic obstructive cardiomyopathy due to the MV being more susceptible to positioning within the LVOT. Wong et al 12 report the effectiveness of MitraClip in the management of MR and SAM in the setting of hypertrophic obstructive cardiomyopathy. Despite the isolated basal septal hypertrophy and marked SAM of the MV, the patient was not noted to have significant LVOT obstruction.…”

Section: Discussionmentioning

confidence: 99%

Successful MitraClip Implantation in a Barlow's Valve: A Feasible Alternative?

Kelley

Gazda

Sivak

et al. 2021

CASE

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“…Several small studies have investigated the transcatheter MV EE procedure (MitraClip) in the setting of HOCM, to reduce SAM and LVOT obstruction. [39][40][41] Although these studies were limited by size and adequate follow-up, the use of Mitraclip is a potential therapeutic option in symptomatic HOCM patients who are not surgical candidates and/or do not have optimal coronary (septal perforator) anatomy for alcohol septal ablation.…”

Section: Future Perspectivesmentioning

confidence: 99%

Mitral regurgitation in hypertrophic obstructive cardiomyopathy: The role of the edge‐to‐edge technique

Lapenna

Alfieri

Nisi

et al. 2021

Journal of Cardiac Surgery

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Mitral regurgitation in hypertrophic obstructive cardiomyopathy (HOCM) is mainly due to systolic anterior motion (SAM) and may be abolished in most of the patients by extended myectomy alone. However, a minority of HOCM patients may present mitral regurgitation due to organic mitral valve (MV) anomalies (such as MV leaflet prolapse, chordal rupture, leaflet cleft, and fibrosis) which need to be addressed. In addition, when the thickness of the interventricular septum is not particularly pronounced, shallow myectomy may not be enough to eliminate SAM and additional procedures have been proposed, including MV replacement, anterior leaflet plication/extension, reorientation of papillary muscles, secondary chordae cutting, and edge-to-edge technique. MV repair in the context of hypertrophic cardiomyopathy is certainly more challenging due to the suboptimal exposure of the MV related to the presence of a hypertrophic left ventricle and a not particularly dilated left atrium. The simplest, least time-consuming repair technique should, therefore, be chosen. In this setting, the edge-to-edge technique has the great

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Killing two birds with one stone—MitraClip for flail P2 and systolic anterior motion of mitral valve: a case report

Cited by 6 publications

References 15 publications

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Successful MitraClip Implantation in a Barlow's Valve: A Feasible Alternative?

Mitral regurgitation in hypertrophic obstructive cardiomyopathy: The role of the edge‐to‐edge technique

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