Abstract
An important complication of the MitraClip procedure is single leaflet detachment. This case illustrates such a complication and demonstrates the echocardiographic and fluoroscopic images associated with it.
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TTE: parasternal LAX w/o color. The parasternal long axis demonstrates mild prolapse of the posterior leaflet with some possible mild restriction of the anterior leaflet during diastole (MP4 4005 kb)
TTE: parasternal LAX w/ color. There is an anteriorly directed jet of mitral regurgitation originating from the site of posterior leaflet prolapse (MP4 4455 kb)
TTE: parasternal SAX. Short axis view shows that the MR has a wide but central jet (MP4 4165 kb)
TTE: apical 4C view. The apical four-chamber view shows biatrial enlargement and left ventricular enlargement(A) (MP4 5082 kb)
TTE: apical 4C view. The regurgitant jet originates centrally and is directed anteriorly(B) (MP4 3231 kb)
TTE: apical 4C magnified. On magnified apical 4C views with a lower Nyquist limit, the large PISA can be appreciated, as well as the width of the mitral regurgitant jet at the level of the leaflets (MP4 3231 kb)
TEE: bicommissural w/ color. The bicommissural view shows a wide central jet (MP4 1340 kb)
TEE: 3C w/o color. On the three-chamber view, the posterior leaflet prolapse is apparent. There is also mild restriction of the anterior leaflet, suggesting a mixed functional/degenerative etiology (MP4 1774 kb)
TEE: 3C w/ color. The Doppler imaging shows the origin of the jet at the line of malcoaptation, and that the jet is directed anteriorly (MP4 1463 kb)
TEE: 4C w/o color. In the four-chamber view, the mild prolapse of P2 is apparent, with concomitant mild tenting of the anterior leaflet (MP4 1521 kb)
TEE: 4C w/ color. The Doppler regurgitant jet is directed anteriorly (MP4 1478 kb)
TEE: Bicom view. The first device is advanced across central portion of the valve (MP4 1733 kb)
TEE: 3C view. Positioning of the device is confirmed in the 3C view as it is advanced (MP4 1914 kb)
TEE: 3C view. The first device is deployed and grasps the anterior and posterior leaflets in a central location (MP4 1914 kb)
TEE: 3C view with Doppler. There is a persistent anteriorly directed jet of mitral regurgitation after deployment of the first device (MP4 1339 kb)
TEE: Bicom view with Doppler. The persistent MR can also be seen in the Bicom view, lateral to the first device (MP4 1743 kb)
TEE: Bicom view. A second device is advanced across the valve lateral to the first device (MP4 1820 kb)
TEE: 3C view with Doppler. Post-deployment of two devices, there is minimal to no MR in the 3C view (MP4 1139 kb)
TTE: parasternal LAX w/ color. The parasternal long axis demonstrates recurrent MR with significant aliasing (MP4 1741 kb)
TTE: apical 4C w/o color. In the A4C view during diastole, the devices appear well aligned and parallel (MP4 4966 kb)
TTE: apical 4C w/o color. In systole, the orientation of the devices has changed, with the more lateral device flipping back into the left atrium. This is consistent with partial clip detachment (MP4 4907 kb)
TTE: A4C with Doppler. On Doppler imaging, there is a large color jet of recurrent MR (MP4 4907 kb)
Fluoro: diastole. In LAO cranial view during diastole, the devices appear well oriented in a stable position relative to the mitral valve leaflets (MP4 4907 kb)
Fluoro: systole. In LAO cranial view during systole, the lateral (second device) changes orientation, consistent with partial clip detachment (MP4 6934 kb)
TTE: parasternal LAX w/o color. After device explant and successful surgical mitral valve repair with partial leaflet resection and annular ring placement, there is good coaptation of the anterior and posterior leaflets. There is a postsurgical large pleural effusion (MP4 6934 kb)
TTE: parasternal LAX w/ color. On Doppler imaging, there is only a trace jet of MR originating near the coaptation of A2 and P2 (MP4 5500 kb)
TTE: apical 4C w/o color. A magnified apical 4C view shows the leaflet coaptation after surgical repair (MP4 2802 kb)
TTE: apical 4C w/ color. There is trace MR by Doppler imaging (MP4 5043 kb)
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Armstrong, E.J., Yeo, K.K., Rogers, J. (2013). EVEREST II: Two MitraClip Procedure with Partial Detachment of Second Device. In: Feldman, T., Franzen, O., Low, R., Rogers, J., Yeo, K.K. (eds) Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair. Springer, London. https://doi.org/10.1007/978-1-4471-4294-2_24
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DOI: https://doi.org/10.1007/978-1-4471-4294-2_24
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Publisher Name: Springer, London
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Online ISBN: 978-1-4471-4294-2
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