Abstract
This case example describes in a step-by-step fashion the evaluation and management of severe MR in a patient with functional MR due to an inferior-basal left ventricular aneurysm in the setting of prior inferior myocardial infarction.
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TTE: parasternal LAX w/o color. The parasternal long axis demonstrates significant tenting of the mitral leaflets below the level of the annulus (MP4 6289 kb)
TTE: parasternal LAX w/color. There is a posteriorly directed jet of mitral regurgitation, consistent with functional MR (MP4 2752 kb)
TTE: parasternal SAX. Short axis view shows that the MR has a central origin along the P2/A2 interface (MP4 4439 kb)
TTE: apical 4C view. The apical four-chamber view shows biatrial enlargement and confirms a posteriorly directed jet of mitral regurgitation resulting from tenting of the posterior leaflet (MP4 4164 kb)
TTE: 2C w/o color. In the apical two-chamber view, the echogenic inferobasal aneurysm is apparent, which is tethering the posterior leaflet (MP4 5200 kb)
TTE 2C: w/color. The jet of mitral regurgitation is moderate to severe by color Doppler (MP4 2876 kb)
TEE: bicommissural w/o color. The bicommissural view shows the large inferobasal aneurysm (MP4 5516 kb)
TEE: bicommissural w/color. There is a significant jet of posterior MR resulting from tethering of the leaflets (MP4 3749 kb)
TEE: 3C w/o color. The three-chamber view confirms a posteriorly directed jet originating at the A2/P2 interface (MP4 6664 kb)
TEE: 3C w/color. There is a large vena contracta and a posteriorly directed jet (MP4 3806 kb)
TEE: 4C w/o color. The four-chamber view shows tenting of the mitral valve leaflets. The annulus is also enlarged (MP4 4724 kb)
TEE: 4C w/color. The regurgitant jet has a central origin (MP4 3657 kb)
TEE: bicaval view. The transseptal needle is advanced across the interatrial septum in a superior and posterior direction (MP4 7853 kb)
Biplane TEE. The MitraClip is advanced across the mitral valve (MP4 9640 kb)
Biplane TEE. Biplane TEE is used to orient the direction of the grasping arms orthogonal to the line of leaflet coaptation (MP4 1682 kb)
TEE: Bicom clip at deployment. Once positioning is confirmed, the device is deployed (MP4 2837 kb)
TEE: Bicom view after clip deployment. Post-deployment, there is a residual jet of MR lateral to the site of clip attachment (MP4 2880 kb)
TEE. A second clip is advanced across the mitral valve (MP4 902 kb)
TEE: biplane views. The second clip is deployed slightly lateral to the first clip (MP4 10431 kb)
TEE: biplane Doppler views after second clip. Post-deployment, there is trace MR (MP4 1168 kb)
Fluoroscopy. Pre-procedure, there is severe mitral regurgitation with associated severe left atrial enlargement and an inferobasal left ventricular aneurysm (MP4 21569 kb)
Fluoroscopy. Post-procedure, there is trace MR, and the two MitraClip devices appear well seated on fluoroscopy (MP4 17401 kb)
TTE: parasternal LAX. Parasternal long axis view show the MitraClips positioned in the center of the valve (MP4 2013 kb)
TTE: parasternal LAX w/color. There is trace mitral regurgitation and normal inflow around the MitraClip devices (MP4 1550 kb)
TTE: 4C w/o color. Apical 4C view shows the MitraClips oriented parallel to the mitral inflow (MP4 2075 kb)
TTE: 4C w color. There is double inlet Doppler flow around the MitraClip devices (MP4 1285 kb)
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Armstrong, E.J., Low, R., Rogers, J. (2013). EVEREST II Functional Mitral Regurgitation. 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_22
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DOI: https://doi.org/10.1007/978-1-4471-4294-2_22
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