Indirect mitral annuloplasty using Carillon device after conduction system pacing resynchronization in patient with severe mitral regurgitation: a case report

Background The prevalence of secondary mitral regurgitation (SMR) is increasing due to the aging population. SMR management is a complex disease because at least 2 pathologies are involved. SMR and severely reduced EF are independent risk factors for adverse outcomes. Case summary We present the case of a 57-year-old man who presented with dyspnea NYHA III. On echocardiography, a combination of SMR and DCM with EF of 20% were diagnosed. Indirect mitral annuloplasty after CRT-CSP was performed based on the patient’s clinical profile and high surgical repair risk. The 3-month follow-up was uneventful. Discussion Mitral valve repair techniques in ventricular SMR with severely reduced EF are controversial due to ongoing debates about long-term repair durability in the setting of left ventricular remodeling. Percutaneous strategies are an alternative for high-risk surgical patients and their indication expanded for more complex anatomy and patient´s comorbidity. Conclusion Indirect mitral annuloplasty with the Carillion device in patients with CRT-CSP due to low EF and severe mitral regurgitation is feasible for the treatment of these combined pathologies and allows more physiological pacing and future M-TEER.