Key result
Transjugular M-TEER successfully reduces severe functional MR to trivial levels at one year.
Why the study?
When the standard transfemoral approach for M-TEER is not feasible, the transjugular approach can serve as an alternative, but technical reports remain limited.
Is transjugular M-TEER feasible and effective for reducing mitral regurgitation in a patient with severe FMR and IVC occlusion?
Case Report (n=1)
Is transjugular M-TEER feasible and effective for reducing mitral regurgitation in a patient with severe FMR and IVC occlusion?
Transjugular M-TEER is a feasible and effective alternative for treating severe functional mitral regurgitation when the standard transfemoral approach is precluded by inferior vena cava occlusion.
May offer alternative access for M-TEER when transfemoral is precluded; leaves open need for prospective validation.
Background: Transcatheter edge-to-edge mitral valve repair (M-TEER) using the MitraClip system is primarily performed using the transfemoral approach. However, when this approach is not feasible, the transjugular approach can be used as an alternative. Case summary: A 57-year-old man presented with heart failure and persistent New York Heart Association class IV symptoms, refractory to guideline-directed medical therapy, intravenous therapy, and intra-aortic balloon pumping. His medical history included pulmonary embolism secondary to deep vein thrombosis, which occluded the inferior vena cava (IVC). Transthoracic echocardiography (TTE) revealed severe functional mitral regurgitation (FMR). The IVC occlusion made the transfemoral approach impossible; hence, transjugular M-TEER was planned. Transseptal puncture was performed via the right internal jugular (RIJ), 32 mm above the mitral annulus. A Confida wire was positioned in the left ventricle, and a steerable guiding catheter was introduced with 180° clockwise rotation of the +knob for septal crossing through the stiff wire. The MitraClip XTW was inserted into the catheter with a 90° counterclockwise rotation. After adjusting to a straddle position to move the clip laterally, additional knob rotations were performed to position the clip at A2/P2. Once the clip was placed, only trivial mitral regurgitation (MR) remained. No complications occurred, and the patient improved, allowing discharge. Transthoracic echocardiography at 1-year post-procedure demonstrated sustained MR reduction. Discussion: We have described the successful completion of M-TEER using the RIJ approach in a patient with severe FMR. Technical considerations in M-TEER require special attention because of limited reports on the M-TEER procedure via the RIJ.
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Enta et al. (2024) conducted a case report in Severe functional mitral regurgitation (n=1). Transjugular transcatheter edge-to-edge mitral valve repair (M-TEER) was evaluated on Mitral regurgitation reduction. Transjugular transcatheter edge-to-edge mitral valve repair successfully reduced severe functional mitral regurgitation to trivial levels, with sustained reduction at 1-year follow-up.
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