IMAGE IN CARDIOLOGY

DOI: 10.4244/EIJV11I5A115

Unintentional sealing of the mitral valve with a second MitraClip. “Once bitten, twice shy”

Arash Alipour, MD, PhD; Martin J. Swaans*, MD, PhD; Martijn C. Post, MD, PhD; Benno J.W.M. Rensing, MD, PhD; Frank D. Eefting, MD; Jan A.S. Van der Heyden, MD, PhD

A 70-year-old woman with known complete thoracic paraplegia, chronic obstructive pulmonary disease and gastrointestinal bleedings was referred for a MitraClip® (Abbott Vascular, Santa Clara, CA, USA) procedure for symptomatic mitral regurgitation (MR). Echocardiography showed moderate-severe MR due to prolapse of degenerated leaflets (Barlow’s disease) (Online Figure 1, Online Figure 2, Moving image 1, Moving image 2).

The first clip was implanted on the origin of the largest MR jet in a lateral position, reducing MR to moderate with a mean gradient of 3-4 mmHg. During closure of the second clip, complete sealing of the mitral valve (MV) occurred with concomitant loss of blood pressure. Echocardiography showed spontaneous contrast in the left atrium (LA) and complete collapse of the left ventricle (LV) (Figure 1, Moving image 3). After re-opening the clip, recovery of haemodynamic state occurred.

Figure 1. Mid-oesophageal transoesophageal long-axis view after closure of the second MitraClip showing dense spontaneous contrast in the LA and a complete collapse of the LV.

This case emphasises that patients with Barlow’s disease may not be suitable for the MitraClip. The highly mobile MV frequently results in residual MR, while grasping the redundant tissue increases the risk of relevant MV stenosis.

Conflict of interest statement

M. Swaans and J. Van der Heyden are proctors for Abbott. The other authors have no conflicts of interest to declare.

Online data supplement

Moving image 3. Mid-oesopheageal transoesophageal long-axis view after closure of the second MitraClip showing dense spontaneous contrast in the LA and a complete collapse of the LV.

Online Figure 1. Mid-oesophageal transoesophageal four-chamber view showing prolapse of both leaflets.

Online Figure 2. Mid-oesophageal transoesophageal four-chamber view with colour showing prolapse of both leaflets causing moderate-severe MR.

Supplementary data

To read the full content of this article, please download the PDF.

Volume 11 Number 5
Sep 22, 2015
Volume 11 Number 5
View full issue


Key metrics

On the same subject

Reply to the letter to the editor

10.4244/EIJ-D-23-00985 Feb 19, 2024
Reply: The ROTA-CUT randomised trial: push the button harder
Sharma S et al

Research Correspondence

10.4244/EIJ-D-23-00743 Feb 19, 2024
Final report of the PROTEMBO C Trial: a prospective evaluation of a novel cerebral protection device during TAVI
Fezzi S et al

Editorial

10.4244/EIJ-E-24-00003 Feb 19, 2024
Between Scylla and Charybdis in atrial functional mitral regurgitation
Denti P
free

Letter to the editor

10.4244/EIJ-D-23-00937 Feb 19, 2024
Letter: The ROTA-CUT randomised trial: push the button harder
Novelli L et al

Original Research

10.4244/EIJ-D-23-00819 Feb 19, 2024
Outcomes of transcatheter edge-to-edge repair for atrial functional mitral regurgitation
Tanaka T et al

Editorial

10.4244/EIJ-E-23-00071 Feb 19, 2024
One-year outcomes with a new mitral edge-to-edge repair device: is mitral TEER about to conquer the world?
Praz F and Samim D
free
Trending articles
170.15

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
159.45

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
127.03

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
108.75

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
99.18

Expert consensus

10.4244/EIJ-E-22-00018 Dec 4, 2023
Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations
Lunardi M et al
free
76.38

State of the art

10.4244/EIJ-D-22-00969 Jun 19, 2023
Functional coronary angiography for the assessment of the epicardial vessels and the microcirculation
Faria D et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved