Functional MR that must be addressed but how?

Functional MR that must be addressed but how?David W. Yaffee, M.D.Cardiothoracic SurgeryNYU School of Medicine

1Functional MR that must be addressed but how?No Disclosures

2Mr. S74M with dilated cardiomyopathy, NYHA Class III CHF, COPD, and atrial fibrillation with FMR

admitted to an OSH 8 months prior to presentation with a CHF exacerbation

TTE demonstrated severe MRFunctional MR that must be addressed but how?

3Mr. S ETT 1 block, 1 flight of stairs two pillow orthopnea nonproductive cough lower extremity edema

symptoms persisted despite medical optimization and he was referred to our institution for further managementFunctional MR that must be addressed but how?

4Functional MR that must be addressed but how?Mr. S

, COPDCath: normal coronaries5Functional MR that must be addressed but how?Mr. S

6

-- severe LA dil (4.5cm, LA vol index 49 ml/mm2)-- mild LVH, normal LVEDD (5.4cm)- EF 35%-- paradoxical septal motion (2/2 LV pacing)7

- mild leaflet thickening- mod-sev MR (EROA 0.33cm2, regurg volume 40ml)- MR jet broad based, central and holocystolic- mean diastolic gradient 1mmHg8Presentation Title Goes Here9

Functional MR that must be addressed but how?Functional MR that must be addressed but how?

-- positioning of MitrClip device across the mitral leaflets10

- 3D reconstructions of the MitraClip in position- Color view shows good flow across the valve with a small regurgitatnt jet to the medial side of the MitraClip11

-- post-deployment echo shows appropriate apposition of the mitral leaflets12

-- Final 2D and 3D color views show good flow across the valve with mild residual MR-- mean diastolic gradient 2-3mmHg, EROA 0.12cm213