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.
ABSTRACT
BACKGROUND: Aortic stenosis imposes a chronic pressure overload on the left ventricle, with attendant adaptations in hemodynamics, muscle mass and performance. The hemodynamic changes that occur during the initial 24 h following abrupt removal of the impediment to left ventricular outflow have not been previously examined. METHODS: A total of 52 patients with right heart catheterization was evaluated before, within 6 h and at 24 h after successful transcatheter aortic valve replacement (TAVR). Echocardiographic data were examined before and within 30 days of the procedure. RESULTS: TAVR was successful in all 52 patients, and at 24 h after the procedure resulted in: (i) an increase in cardiac index (CI) (from 2.0 ± 0.6 to 3.1 ± 0.7 l/min/ m2, p <0.001) and stroke volume (SV) (from 62.3 ± 18.7 to 76.6 ± 21.3 ml, p <0.001); (ii) reductions in systemic vascular resistance (from 1555 ± 458 to 1021 ± 280 dyne·s/cm5, p <0.001) and pulmonary vascular resistance (from 174 ± 150 to 112 ± 76 dyne·s/cm5, p = 0.001); (iii) reductions in pulmonary capillary wedge pressure (from 24.2 ± 6.7 to 19.7 ± 7.3 mmHg, p <0.001), mean pulmonary artery pressure (from 32.2 ± 9.9 to 27.5 ± 8.8 mmHg, p = 0.002) and in central venous pressure (from 13.5 ± 4.8 to 9.4 ± 3.9 mmHg, p <0.001); and (iv) an increase in systolic arterial pressure (from 127 ± 25 to 135 ± 14 mmHg, p = 0.04), along with a decrease in diastolic arterial pressure (from 58 ± 11 to 53 ± 9 mmHg, p = 0.009). CONCLUSIONS: Successful TAVR results in immediate and sizeable improvements in SV and CI, reductions in left and right ventricular filling pressures, and marked reductions in systemic and pulmonary vascular resistances.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Hemodynamics , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization , Echocardiography, Doppler , Female , Humans , Male , Recovery of Function , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome , Ventricular Function, Left , Ventricular Function, RightABSTRACT
The MitraClip procedure is an important procedure for the treatment of high-risk patients with severe MR, offering an effective and clinically meaningful reduction in the degree of MR, with low perioperative morbidity and mortality. Careful screening of prospective patients and evaluation by the multidisciplinary Heart Team are essential. A dedicated interventional team combining technical skills and advanced imaging is critical for success.
Subject(s)
Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve Annuloplasty/methods , Patient Selection , Prosthesis Design , Treatment OutcomeABSTRACT
Clinically significant mitral prosthetic paravalvular leaks may occur in up to 5% of patients following surgical mitral valve replacement. Successful closure may offer relief from symptoms of heart failure and hemolysis, but surgical closure is associated with increased morbidity and mortality. Alternative transcatheter closure techniques are being developed. We present a patient who was successfully treated via a transapical approach with deployment of an amplatzer duct occluder type I closure device under real-time two-dimensional transesophageal echocardiography.
