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Type: Case Report
Title: Mitral p2 perforation during mitraclip grasping manoeuver, intraprocedural detectation
Authors: Maria-Cruz Ferrer-Gracia
Affiliations: Hemodynamic and Interventional Cardiology Unit, Cardiology Institution, Miguel Servet University Hospital, Zaragoza, Spain.
Abstract: We present a leaflet perforation in an old woman after the first attempt of grasping manoeuvre. During final echocardiographic verifications, just before the releasing of the clip, her mitral regurgitation was worsened. Therefore, we decided to invert the clip and return to the left atrium. After an exhaustive scanning, we observed a new jet inside one leaflet (P2) of the mitral valve. For fear that a new grasping would cause a new jet, a surgical approach was decided to be performed.Intraoperatory images confirmed the tear in the middle of P2. A mechanical mitral prosthesis was successfully implanted and the patient nicely recovered. Mitral leaflet disruption is a rare but serious complication of Mitraclip insertion. In previous reported cases, this condition was observed just in patients who required a surgical approach after clip implantation. Never before has it been described during grasping manoeuvres without liberation of the clip.
Title: Patient selection for transcatheter mitral valve repair vs. replacement: ongoing indications and a glimpse into the future
Authors: Andrea Scotti1, Cosmo Godino2
Affiliations: 1Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
2Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
Corresponding Author: Cosmo Godino, MD, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute Via Olgettina 60, 20132 Milan, Italy. E-mail: firstname.lastname@example.org
Abstract: Transcatheter therapies for patients with severe mitral regurgitation have been increasingly performed in recent years. While transcatheter mitral valve repair (TMVR) is now a consolidated intervention with > 100,000 procedures performed worldwide, TMV replacement (TMVRpl) is in its early stages and can only be performed by few centers. The complexity of mitral valve anatomy requires careful evaluation in selecting the best approach and the most suitable device. At present, the clinical experience with TMVRpl is still in a preliminary phase. Most of the patients treated with this approach currently are really high-risk candidates who have undergone a very restrictive clinical and anatomical selection. Therefore, it is difficult to accurately define which patients might benefit more from TMVRpl than from TMVR. Hereafter, we review the clinical, pathophysiological and technical factors to suggest when to prefer TMVR to a replacement technique.
Keywords: Mitral regurgitation, mitral valve repair, mitral valve replacement