Recurrent Mitral Regurgitation After Previous Alfieri Stitch , A Case Of Transcatheter Mitral Edge-to-edge Repair
Attaullah Khan Niazi1, Mohammed Sharif2.
1Shalamar Hospital Lahore, Lahore, Pakistan, 2Punjab institute of Cardiology, Lahore, Pakistan.
BACKGROUND: 72 year old male, wheelchair bound due to NYHA Class III symptoms with clinical signs of heart failure Past Medical History: AorticrootreplacementwithbioprostheticAVR (2015) and Alfieri repair to mitral valve , Residual moderate-severe mitral regurgitation post-operatively Permanent atrial fibrillation Amiodarone induced thyroid dysfunction
Transoesophageal echocardiogram Severe mitral regurgitation secondary to P2/P3 prolapse Mild left ventricular impairment in the context of severe mitral regurgitation (ejection fraction 50%) Well seated bioprosthetic aortic valve with normal function (MV mean gradient < 2mmHg Suitable anatomy for Mitral TEER)
METHODS:
Procedural details Day-case procedure General anaesthetic/ Transoesophageal echo- guided Device:PascalACE(EdwardsLifesciences) Access: 11F right femoral vein, pre-closed with 2 x Proglides Transseptal puncture positioned mid- posteroseptumImplantpositionedmedialtoAlfieristitch(over dominant jet)
RESULTS:
Final Result Stable device position Mild residual MR Mitral valve mean gradient unchanged (<3mmHg)
CONCLUSIONS:
This case highlights the differences between the Alfieri procedure vs transcatheter edge-to-edge repair (TEER) i. Ability to check the final result in TEER before the end of the procedure under haemodynamically normal conditions ii. Can try multiple positions of device and optimise leaflet grasp to get the best possible result Demonstrates the maneuverability of the Pascal device in challenging anatomy
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