Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve 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 po sterior 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 re stricted 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 percu taneous repair can allow for dramatic reduction in MR, resulting in significant left ventricular remodeling and improvement of EF and cardiac output.

Source: Catheterization and Cardiovascular Interventions - November 15, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Richard Cheng, Saibal Kar, Robert J. Siegel, Mamoo Nakamura Tags: VALVULAR AND STRUCTURAL HEART DISEASES Source Type: research