MitraClip Implantation for the Treatment of New-Onset Systolic Anterior Motion of the Mitral Valve After Transcatheter Aortic Valve Replacement

Grasso, Carmelo; Scandura, Salvatore; Buccheri, Sergio; Barbanti, Marco; Salvo, M.; Mangiafico, Sarah; Ronsivalle, Giuseppe; Immè, Sebastiano; Tamburino, C; Patané, Martina; Sgroi, Carmelo; Capodanno, Davide; Capranzano, Piera; Tamburino, Corrado

doi:10.1016/j.athoracsur.2016.05.032

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…Following aortic stenosis interventions, SAM is an often unrecognized cause of hemodynamic instability ( 3 ). One of the proposed pathophysiological explanations is that, by relieving the LVOT obstruction imposed by the aortic stenosis, the LVOT pressure drops, thereby reducing the LVOT cross-sectional area resulting from high-velocity flow (Bernoulli theorem).…”

Section: Discussionmentioning

confidence: 99%

“…One of the proposed pathophysiological explanations is that, by relieving the LVOT obstruction imposed by the aortic stenosis, the LVOT pressure drops, thereby reducing the LVOT cross-sectional area resulting from high-velocity flow (Bernoulli theorem). This “low-pressure zone” would affect the MV apparatus directly by “pulling” the anterior leaflet toward the LVOT ( 3 ). After aortic regurgitation interventions, although possible, SAM is rarer once the dilated left ventricle tends to widen during systole, thus preventing anterior leaflet-LVOT apposition ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…The MitraClip system (Abbott Laboratories, Abbott Park, Illinois) has been used to manage new onset SAM after MV repair ( 2 ) or aortic valve (AV) interventions ( 3 ). Clinical hemodynamic outcomes suggest that it could be a feasible and safe alternative in these settings ( 4 ).…”

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confidence: 99%

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SAM and Severe Mitral Regurgitation Post–Acute Type A Aortic Dissection Surgery Treated With MitraClip

et al. 2020

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Post-operative systolic anterior motion associated with mitral regurgitation can be a challenging combination. We present the case of a 64-year-old male patient managed by MitraClip (Abbott Laboratories, Abbott Park, Illinois) implantation for systolic anterior motion and severe mitral regurgitation in the early post-operative period after aortic dissection surgery. This is the first description of MitraClip use post–aortic dissection. ( Level of Difficulty: Intermediate. )

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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SAM and Severe Mitral Regurgitation Post–Acute Type A Aortic Dissection Surgery Treated With MitraClip

et al. 2020

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“…In cardiac patients this condition is seen in patients with HOCM, apical ballooning syndrome, or following mitral valve surgery in which the geometry of the annulus has been changed and the annular conformation leads to SAM (7). Surgical or percutaneous aortic valve replacement may represent a cause of post-operative SAM and hypotension, albeit 1.6% (8). There are case reports in the literature describing acute perioperative hypotension in non-cardiac surgery, these include laparoscopic surgery, hepatobiliary surgery, orthopedic surgery, and major abdominal procedures (2,6,9-11).…”

Section: Discussionmentioning

confidence: 99%

Systolic anterior motion of the mitral valve—the mechanism of postural hypotension following left intrapericardial pneumonectomy

Lasala

Tsai²,

Rodríguez-Restrepo

et al. 2017

J. Thorac. Dis.

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Systolic anterior motion (SAM) is defined as displacement of the distal portion of the anterior leaflet of the mitral valve toward the left ventricular outflow tract obstruction. SAM can occur in patients without hypertrophic cardiomyopathy (HOCM) and is a well-recognized cause for unexplained sudden hypotension in perioperative settings. We present a case of persistent orthostatic hypotension caused by SAM following left intrapericardial pneumonectomy and mediastinal lymph node dissection for squamous cell carcinoma of the lung invading intrapericardial portion of the inferior pulmonary vein. Diagnosis of SAM was possible with the use of transesophageal echocardiography (TEE). J Thorac Dis 2017;9(4):E354-E357 jtd.amegroups.com utilizing 60 mm TA stapler with blue (3.5 mm) staple load. Essentially all pericardium to the left of the midline was also resected en bloc with the specimen. Since the heart was laying anatomically oriented in the left chest without any tension on the venous return, and because of the very large size of pericardial defect, the pericardium was not reconstructed. Chest cavity was closed with one drain in place connected to post pneumonectomy pleurovac.Patient remained hemodynamically stable for the first 24 hours, however, on postoperative day (POD) 2 started experiencing severe postural hypotension {81/53 [62] mmHg}, which temporarily responded to fluid boluses, and subsequently required phenylephrine infusion at 50 mcg per minute. Patient also manifested hepatojugular reflux with jugular venous distention. Right heart failure and pulmonary hypertension were considered in the differential diagnosis, and bedside transesophageal echocardiography (TEE) showed the right ventricle mildly dilated with mildly depressed right ventricular systolic function, dilation of the right atrium, and left atrium small in size. Computed tomography (CT) scan of the chest, however, demonstrated evidence of left atrial compression, suggesting dynamic obstruction of the venous return from the remaining right-sided pulmonary veins (Figure 2). Due to the patient's hemodynamic instability off of phenylephrine, the decision was made to take the patient back to the operating room for a redo thoracotomy and a pericardial reconstruction with bovine pericardium (12×25 cm bovine pericardium) on POD 4.On arrival to the operating room, patient was in the supine position and demonstrated stable hemodynamics with four liters of supplemental oxygen and phenylephrine infusion at 0.3 mcg/kg/min. A pre-induction arterial line was placed and vital signs were as follows; blood pressure 139/72 [99] mmHg, heart rate of 84 bpm, respiratory rate of 14, and oxygen saturation of 95%. After a smooth induction the patient was easily intubated with a single lumen endotracheal tube. A 9-French central line was placed in the right internal jugular vein with ultrasound guidance. Upon insertion of the central line, the patient's baseline CVP was 23 mmHg in supine position. An orogastric tube was inserted to empty and decompress the...

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“…Transcatheter aortic valve replacement (TAVR) is the recommended treatment for patients with symptomatic severe aortic stenosis (AS) who are inoperable or at high or intermediate surgical risk 1,2 . In patients with concomitant systolic anterior motion (SAM) of the mitral valve leading to significant left ventricular outflow tract (LVOT) obstruction, there is a risk for the development of “suicide left ventricle,” which manifests as potentially fatal hemodynamic instability after TAVR due to a rapid drop in afterload related to the sudden relief of aortic valve stenosis in susceptible patients with significant septal hypertrophy 3‐7 . In most cases, these hemodynamic shifts can be managed medically with fluid resuscitation and various pharmacologic methods to increase afterload and decrease heart rate 3 .…”

Section: Introductionmentioning

confidence: 99%

The use of MitraClip to prevent posttranscatheter aortic valve replacement left ventricular “suicide”

Bode

Ahmed

Baron

et al. 2020

Cathet Cardio Intervent

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Patients with concomitant severe aortic stenosis (AS) and left ventricular outflow tract (LVOT) obstruction undergoing transcatheter aortic valve replacement (TAVR) are at risk for hemodynamic collapse due to a sudden decrease in afterload causing worsening LVOT obstruction. We present a case of an 88‐year‐old female with symptomatic, severe AS, and LVOT obstruction with systolic anterior motion (SAM) of the mitral leaflet in whom alcohol septal ablation was contraindicated secondary to a chronic total occlusion of the right coronary artery that filled retrograde via septal collaterals. MitraClip at the time of TAVR was successfully performed to treat SAM with subsequent stabilization of LVOT gradients despite treatment of the patient's AS. This novel approach may represent a feasible option to prevent hemodynamic complications after TAVR in patients with significant LVOT obstruction secondary to SAM and AS.

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MitraClip Implantation for the Treatment of New-Onset Systolic Anterior Motion of the Mitral Valve After Transcatheter Aortic Valve Replacement

Cited by 7 publications

References 3 publications

SAM and Severe Mitral Regurgitation Post–Acute Type A Aortic Dissection Surgery Treated With MitraClip

SAM and Severe Mitral Regurgitation Post–Acute Type A Aortic Dissection Surgery Treated With MitraClip

Systolic anterior motion of the mitral valve—the mechanism of postural hypotension following left intrapericardial pneumonectomy

The use of MitraClip to prevent posttranscatheter aortic valve replacement left ventricular “suicide”

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