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      Edge-to-edge mitral valve repair for acute mitral valve regurgitation due to papillary muscle rupture: a case report

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          Abstract

          Background

          Papillary muscle (PM) rupture is a devastating mechanical complication of myocardial infarction that leads to cardiogenic shock and death. In this case, we report a patient with acute mitral regurgitation due to PM rupture that was treated successfully with MitraClip.

          Case summary

          An 85-year-old female patient with anterior ST-elevation myocardial infarction complicated with PM rupture and acute severe mitral regurgitation was admitted to our hospital. The patient’s surgical risk was considered to be prohibitively high, and was therefore, referred for transcatheter edge-to-edge repair with MitraClip. The procedure was successful, and the patient was discharged home in a stable condition.

          Discussion

          Acute mitral regurgitation due to PM rupture is a mechanical complication of myocardial infarction that should be treated early because of high mortality rates. This case highlights the role of MitraClip in acute mitral regurgitation and acute heart failure as an alternative to surgery method in high-risk patients.

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          Most cited references11

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          Percutaneous repair or surgery for mitral regurgitation.

          Ted Feldman, Elyse Foster, Donald Glower … (2011)
          Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. We randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite end point for efficacy was freedom from death, from surgery for mitral-valve dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months. The primary safety end point was a composite of major adverse events within 30 days. At 12 months, the rates of the primary end point for efficacy were 55% in the percutaneous-repair group and 73% in the surgery group (P=0.007). The respective rates of the components of the primary end point were as follows: death, 6% in each group; surgery for mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral regurgitation, 21% versus 20%. Major adverse events occurred in 15% of patients in the percutaneous-repair group and 48% of patients in the surgery group at 30 days (P<0.001). At 12 months, both groups had improved left ventricular size, New York Heart Association functional class, and quality-of-life measures, as compared with baseline. Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. (Funded by Abbott Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.).
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            Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients.

            Rick A. Nishimura, Hartzell V Schaff, Clarence Shub … (1983)
            The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from less than 24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.
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              AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

              RA NISHIMURA, CM Otto, RO BONOW … (2017)
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Timothy C Tan: Role: Handling Editor
                Christian Jøns: Role: Editor
                Mark Philip Cassar: Role: Editor
                Mohammed Akhtar: Role: Editor
                Peysh A Patel: Role: Editor
                Journal
                Journal ID (nlm-ta): Eur Heart J Case Rep
                Journal ID (iso-abbrev): Eur Heart J Case Rep
                Journal ID (publisher-id): ehjcr
                Title: European Heart Journal: Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2514-2119
                Publication date Collection: March 2019
                Publication date (Electronic): 06 February 2019
                Publication date PMC-release: 06 February 2019
                Volume: 3
                Issue: 1
                Electronic Location Identifier: ytz001
                Affiliations
                Transcatheter Heart Valves Department, HYGEIA Hospital, Erythrou stavrou 9 str, Marousi, Athens 15123, Greece
                Author notes
                Corresponding author. Tel: +30 210 686 7311, Fax: +30 210 686 7299, Email: papadocardio@ 123456gmail.com
                Article
                Publisher ID: ytz001
                DOI: 10.1093/ehjcr/ytz001
                PMC ID: 6439366
                PubMed ID: 31020246
                SO-VID: 7195c66c-b540-45d0-816e-eed1f033ab5c
                Copyright © © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 08 January 2019
                Date accepted : 14 January 2019
                Page count
                Pages: 4
                Categories
                Subject: Case Reports

                Keywords: mitraclip,edge-to-edge repair,acute mitral regurgitation,acute heart failure,papillary muscle rupture,case report
                Data availability:
                Keywords: mitraclip, edge-to-edge repair, acute mitral regurgitation, acute heart failure, papillary muscle rupture, case report

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