Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair

Catheter Cardiovasc Interv. 2019 May 1;93(6):1161-1164. doi: 10.1002/ccd.27980. Epub 2018 Nov 15.

Abstract

Repair of mitral regurgitation (MR) with the MitraClip device (Abbot Vascular, Menlo Park, CA) to treat degenerative MR is associated with improved acute and long-term outcomes. There is an increasing adoption of the device and operators are now testing the limits of the therapy even for unfavorable anatomies. Isolated cleft mitral leaflets are rare but represent a challenge to percutaneous repair. We present two cases of successful repair of severe MR and cleft mitral leaflets. In the first case, a 52-year-old male with a dilated cardiomyopathy and an ejection fraction (EF) of 15% presented in decompensated heart failure. Workup revealed a pseudo-cleft anterior mitral leaflet and a cleft posterior leaflet. A strategy to treat the restricted posterior leaflet lateral of the posterior cleft with a provisional second clip resulted in trace residual MR with only one clip, and an EF improvement to 50% at 2-month follow-up. In the second case, an 80-year-old male with a history of obstructive CAD with a normal EF but severe MR and a restricted anterior leaflet presented with severe shortness of breath. An initial strategy to grasp the middle of the valve was unsuccessful due to the cleft. Instead, two clips were placed side-by-side on either side of the cleft resulting in trivial residual MR. Despite challenging anatomy percutaneous repair can allow for dramatic reduction in MR, resulting in significant left ventricular remodeling and improvement of EF and cardiac output.

Keywords: heart failure; mitral valve disease; percutaneous intervention; structural heart disease intervention.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Aged, 80 and over
  • Cardiac Catheterization* / instrumentation
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery*
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery*
  • Recovery of Function
  • Severity of Illness Index
  • Treatment Outcome
  • Ventricular Function, Left
  • Ventricular Remodeling