Abstract
This case highlights successful MitraClip implantation in a patient with severe kyphoscoliosis. The associated anatomic rotation made MitraClip placement extremely challenging.
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TTE: Apical 4C with and without Doppler. Transthoracic imaging in this patient was technically difficult due to his cardiac rotation, and adequate parasternal images could not be obtained. In this apical four-chamber view, the thickened leaflets can be appreciated. There is an eccentric jet of severe mitral regurgitation (MP4 3717 kb)
TTE: Apical 2C with and without Doppler: In the apical 2-chamber view, the Doppler jet of mitral regurgitation can be seen throughout most of the left atrium, consistent with severe mitral regurgitation (MP4 3933 kb)
TEE: 4C view without color: There is bileaflet prolapse with a central area of coaptation (MP4 12679 kb)
TEE: 4C view with color: The regurgitant jet originates from the A2-P2 interface but has an eccentric course (MP4 3354 kb)
TEE: Bicom view without color: The anterior leaflet has significant prolapse along its lateral border. Due to the patient’s rotation, bicommisural imaging was challenging (MP4 16467 kb)
TEE: Bicom view with color: The regurgitant jet appears to have a single central origin (MP4 3827 kb)
TEE: 3C without color: The leaflets appear thickened, but there is no evidence of chordal rupture (MP4 14538 kb)
TEE: 3C with color: The regurgitant jet has a central origin with a jet that is directed anteriorly (MP4 2771 kb)
TEE: The transseptal puncture site is confirmed at 3.65 cm above the site of leaflet coaptation. This height provided height to allow angulation of the MitraClip delivery system toward the leaflets (MP4 12460 kb)
TEE: Short axis views show that the puncture site is somewhat anterior but acceptable for device orientation relative to the mitral valve (MP4 12295 kb)
Fluoroscopy: A 0.014″ extra-support wire was looped in the left atrium to provide support while removing the Agilis catheter and advancing the Mullins sheath across the interatrial septum (MP4 709 kb)
Fluoroscopy: An Amplatz super-stiff wire is across the interatrial septum. This provides some straightening and support for the MitraClip guiding catheter (MP4 10611 kb)
Fluoroscopy: The MitraClip guiding catheter is directed around the angulation of the inferior vena cava to the interatrial septum. The dilator was maximally extended to facilitate tracking the tortuosity. Patience was required as the MitraClip guiding catheter was advanced across the interatrial septum to avoid prolapsing the wire back into the right atrium (MP4 9038 kb)
Biplane TEE: Biplane views show the MitraClip device across the central zone of coaptation with good orientation. Note that because of lack of sufficient height, the MitraClip guide was brought back into the right atrium to allow the MitraClip to be retracted sufficiently for leaflet grasping (MP4 10258 kb)
TEE: Post deployment, the MitraClip appears well seated at the central A2-P2 interface (MP4 12142 kb)
TEE w/color: Doppler echocardiography reveals mild residual MR around the site of device deployment (MP4 2820 kb)
TEE w/color: On three-chamber views, there is a persistent mild jet of mitral regurgitation (MP4 558 kb)
TTE: On parasternal long axis views, the device appears well seated in a central location (MP4 4047 kb)
TTE: Two-chamber views also confirm a central location of the device (MP4 3596 kb)
TTE: On four-chamber views with and without Doppler, the mitral regurgitation is eccentric and mild (1–2+) (MP4 2917 kb)
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Armstrong, E.J., Rogers, J. (2013). MitraClip Placement in a Patient with Severe Kyphoscoliosis and Bileaflet Prolapse. 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_47
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DOI: https://doi.org/10.1007/978-1-4471-4294-2_47
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Publisher Name: Springer, London
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Online ISBN: 978-1-4471-4294-2
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