MitraClip Case Presentation -...
112
MitraClip Case Presentation M. Chrissoheris Department of Transcatheter Heart Valves Tuesday, March 10, 15
Transcript of MitraClip Case Presentation -...
MitraClip Case Presentation
M. ChrissoherisDepartment of Transcatheter Heart
Valves
Tuesday, March 10, 15
Disclosures
- Proctoring activities for Abbott Vascular
I and the HYGEIA Hospital «Heart Team» have receivedresearch and/or travel grants and/or lecture fees from:- ABBOTT Vascular, Europe
HYGEIA Hospital Heart Team
Cardiologists: A Halapas, M Chrissoheris, K SpargiasCT Surgeons: N Boumboulis, S Skardoutsos, A Tsolakis, S PattakosAnesthesiologist: I Nikolaou, C NastoulisCongenital Cardiology: A TzifaVascular Surgeons: I Belos, S KaliafasRadiologists: C Mourmouris, F Laspas
Tuesday, March 10, 15
The patient• 61 year-old female with exertional
dyspnea• NYHA III-IV• Severe degenerative mitral regurgitation• Prolapse / flail anterior leaflet
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Vena Contracta Area
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
The patient• 61 year-old female with exertional dyspnea• NYHA III-IV, normal coronaries• Severe degenerative mitral regurgitation– Prolapse / flail anterior leaflet
• Severe pulmonary hypertension (3/2014)– PA 120/60mmHg, PVR 13 Wood U.• No reversibility with Ventavis• Wedge 54mmHg
• Atrial fibrillation, morbid obesity (BMI 41kg/
Tuesday, March 10, 15
Heart Team Discussion• Logistic Euroscore 4.7%, STS 28%• Ideally a surgical MV repair patient but…• Inoperable due to critical pulmonary
hypertension, dilated / dysfunctional right ventricle and morbid obesity
• Referral for TMVR with MitraClip
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Tuesday, March 10, 15
Baseline Final
Tuesday, March 10, 15
Baseline Final
Tuesday, March 10, 15
Baseline PV flow Final PV flow
Tuesday, March 10, 15
Tuesday, March 10, 15
Post Procedure Course• Fluoroscopy time 30min12sec• Atrial fibrillation during procedure ! SR• ICU stay 24 hours• Discharge home on day 5 post procedure– Uneventful hospital stay
Tuesday, March 10, 15
Tuesday, March 10, 15
Ischemic/Functional MR ! 77 year-old male, NYHA IV heart failure! Old inferolateral infarct (PCI stent LCx)! Ischemic mitral regurgitation (4+)! Moderate LV dilatation, EF ~40%! Severe pulmonary hypertension (sPAP 61mmHg)! Sarcoidosis on steroids, permanent pacemaker! Euroscore 21.4%, STS 5.4%
! Heart Team discussion
! Severe Functional Ischemic MR! On maximal medical Rx, not a CRT candidate! Surgical option to repair or replace the mitral valve! However no other strong surgical indication (no need for CABG)! Given increased risk " Consensus for transcatheter mitral valve
repair
Tuesday, March 10, 15
Ischemic CardiomyopathyPML tethering
Tuesday, March 10, 15
Ischemic CardiomyopathyPML tethering
Tuesday, March 10, 15
Ischemic CardiomyopathyPML tethering
Tuesday, March 10, 15
X-Plane with Color
Commisural LVOT-long axis
Case 1: The Typical Ischemic/Functional MR
Tuesday, March 10, 15
X-Plane with Color
Commisural LVOT-long axis
Case 1: The Typical Ischemic/Functional MR
Tuesday, March 10, 15
X-Plane with Color
Commisural LVOT-long axis
Case 1: The Typical Ischemic/Functional MR
Tuesday, March 10, 15
3D Full Volume with Color Doppler
Tuesday, March 10, 15
3D Full Volume with Color Doppler
Tuesday, March 10, 15
3D Full Volume with Color Doppler
Tuesday, March 10, 15
Mitral Valve Quantification: Tethering of both leaflets " Functional MR
Tuesday, March 10, 15
Mitral Valve Quantification: Tethering of both leaflets " Functional MR
Vena contracta area 0.9cm2 Tuesday, March 10, 15
3D–Focused Wide Sector (Zoom)
Anatomically oriented mitral valve (surgeon’s view)
Ao
LAA
Tuesday, March 10, 15
3D–Focused Wide Sector (Zoom)
Anatomically oriented mitral valve (surgeon’s view)
Ao
LAA
Tuesday, March 10, 15
Insertion of SLO 8F and Steerable Guide Catheter
Tuesday, March 10, 15
Insertion of SLO 8F and Steerable Guide Catheter
Tuesday, March 10, 15
Insertion of Steerable Guide
Tuesday, March 10, 15
Insertion of Steerable Guide
Tuesday, March 10, 15
Insertion of Steerable Guide
Tuesday, March 10, 15
Insertion of Steerable Guide
Tuesday, March 10, 15
MitraClip over Mitral Valve:Arms should be vertical to coaptation line
Tuesday, March 10, 15
MitraClip over Mitral Valve:Arms should be vertical to coaptation line
Tuesday, March 10, 15
MitraClip over Mitral Valve:Arms should be vertical to coaptation line
Tuesday, March 10, 15
MitraClip: Grasping in LVOT long axis view
Tuesday, March 10, 15
MitraClip: Grasping in LVOT long axis view
Tuesday, March 10, 15
First Clip in A2-P2 region
Tuesday, March 10, 15
First Clip in A2-P2 region
Tuesday, March 10, 15
Post 1st Clip Evaluation: MV area
Lateral Orifice 1.10cm2
Medial Orifice 2.10cm2
Tuesday, March 10, 15
Post 1st Clip Evaluation: MV area
Lateral Orifice 1.10cm2
Medial Orifice 2.10cm2
Tuesday, March 10, 15
Post 1st Clip Evaluation: MV area
Lateral Orifice 1.10cm2
Medial Orifice 2.10cm2
Tuesday, March 10, 15
After 1st M-Clip: Residual moderate MR (medially)
Tuesday, March 10, 15
After 1st M-Clip: Residual moderate MR (medially)
Tuesday, March 10, 15
After 1st M-Clip: Residual moderate MR (medially)
Tuesday, March 10, 15
2nd Clip over Mitral Valve: Assessment for perpendicularity
Tuesday, March 10, 15
2nd Clip over Mitral Valve: Assessment for perpendicularity
Tuesday, March 10, 15
2nd Clip over Mitral Valve: Assessment for perpendicularity
Tuesday, March 10, 15
2nd Clip positioning
Tuesday, March 10, 15
2nd Clip positioning
Tuesday, March 10, 15
Final Result
Baseline
Tuesday, March 10, 15
Final Result
Baseline
Tuesday, March 10, 15
Final Result
Baseline
Tuesday, March 10, 15
Final Evaluation:Mitral Valve Area 2.14cm2
Lateral Orifice 0.8cm2
Medial Orifice 1.34cm2
Tuesday, March 10, 15
Final Evaluation:Mitral Valve Area 2.14cm2
Lateral Orifice 0.8cm2
Medial Orifice 1.34cm2
Tuesday, March 10, 15
Final Evaluation:Mitral Valve Area 2.14cm2
Lateral Orifice 0.8cm2
Medial Orifice 1.34cm2
Tuesday, March 10, 15
