Successful MitraClip for severe rheumatic mitral regurgitation: a case report

Abstract

Background Anatomical exclusion criteria for the MitraClip procedure have included rheumatic heart disease (RHD) involving the mitral valve. This was primarily because RHD is typically associated with mitral stenosis (MS). Case summary We report the case of an 85-year-old male who had recurrent heart failure admissions from severe rheumatic mitral regurgitation (MR). This was successfully treated with the MitraClip system. Discussion Our case demonstrated the possibility of rheumatic MR being treated by the MitraClip system in appropriately selected patients. Careful examination of the mechanism of MR to determine suitability for MitraClip must be done as well as exclusion of significant MS.

Successful treatment of severe primary mitral regurgitation due to rheumatic aetiology using a novel‐designed transcatheter edge‐to‐edge repair system

“…The TEER procedure is now an established therapeutic option for patients with symptomatic, severe, and high surgical-risk MR. [1][2][3][4][5][6][7] However, patients with active RHD or leaflets degenerated from the rheumatic disease were excluded from two significant trials (the EVEREST II 6 and COAPT 7 trials). This may be due to the features of rheumatic mitral disease, including thickened, calcified, and restricted mitral valve leaflets, which may lead to valve stenosis after TEER.…”

“…Moreover, literature on the safety and durability of TEER in rheumatic MR patients was scarce. [2][3][4] In the present case of rheumatic MR, the patient was considered eligible for the TEER procedure by a complete evaluation of TEE.…”

“…It has been reported that the TEER procedures could be safely and effectively performed in carefully selected rheumatic MR patients. [2][3][4] Rogers and his colleagues also reported that the MitraClip G4 system is an option for patients with anatomy at risk of stenosis who need TEER surgery. 5 In the present case, we share the experience of successfully treating a severe rheumatic MR patient using a novel-designed TEER system (JensClip TM ).…”

“…Although the prevalence of rheumatic heart disease (RHD) is really high worldwide, rheumatic MR has always been recognized as a contraindication to TEER, since, generally, it presents with valve thickening and calcification and reduce leaflets mobility, which might increase the risk of postoperative valve stenosis). It has been reported that the TEER procedures could be safely and effectively performed in carefully selected rheumatic MR patients 2–4 . Rogers and his colleagues also reported that the MitraClip G4 system is an option for patients with anatomy at risk of stenosis who need TEER surgery 5 .…”

Percutaneous mitral valve repair in acute mitral regurgitation: case report and review of the literature

“…Finally, rheumatic heart disease is commonly regarded as a contraindication to MitraClip procedures, owing to high risk of mitral stenosis. However, a recently published case report has shown the feasibility of percutaneous MV repair in a rheumatic MV with baseline mean gradients inferior to 4 mmHg [26] . Accurate measurement of MV area through 3D-based multiplanar reconstruction, evaluation of trans-mitral mean gradients and exclusion of calcifications at the grasping area are essential to decision-making and preoperative planning.…”