The Use of MitraClip for Nonobstructive Hypertrophic Cardiomyopathy with Mixed Severe Mitral Valve Regurgitation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Nonobstructive hypertrophic cardiomyopathy with severe mitral valve regurgitation (n=1). Intervention: Transcatheter edge-to-edge repair (TEER) with MitraClip. Primary outcome: Symptomatic improvement and reduction in mitral regurgitation severity.

Jie Zeng; Qinglan Shu; Cong Lu; Yi Wang

doi:10.1002/ehf2.14291

January 20, 2023ESC Heart FailureOpen Access

The Use of MitraClip for Nonobstructive Hypertrophic Cardiomyopathy with Mixed Severe Mitral Valve Regurgitation

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Key result

MitraClip reduces severe mitral regurgitation to mild and improves symptoms to NYHA Class II.

n=1

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Why the study?

Reports on treating nonobstructive hypertrophic cardiomyopathy and severe mitral valve regurgitation with transcatheter edge-to-edge repair are rare.

Does transcatheter edge-to-edge repair with MitraClip improve symptoms and reduce mitral regurgitation in patients with nonobstructive hypertrophic cardiomyopathy and severe mitral regurgitation?

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does transcatheter edge-to-edge repair with MitraClip improve symptoms and reduce mitral regurgitation in patients with nonobstructive hypertrophic cardiomyopathy and severe mitral regurgitation?

P

Population

1 68-year-old Chinese man with nonobstructive hypertrophic cardiomyopathy, severe mitral valve regurgitation, and NYHA Class IV heart failure despite maximal medical therapy, followed for 4 months.

I

Intervention

Transcatheter edge-to-edge repair (TEER) with MitraClip (single XTr device)

O

Outcome

Symptomatic improvement (NYHA class) and MR severity reduction at 4 monthssurrogate

MitraClip may be a feasible and effective option for reducing severe mitral regurgitation and improving symptoms in patients with nonobstructive hypertrophic cardiomyopathy who are at high risk for surgery.

Limitations

Single case report
Short-term follow-up of 4 months
Short-term follow-up
Pathophysiological role of MR in symptoms of nonobstructive HCM is unclear
Mechanism of MR in nonobstructive HCM varies among patients

Implication

TEER may relieve symptoms in high-risk nonobstructive HCM with severe MR; leaves open need for prospective trials before adoption.

Abstract

Reports on the treatment of nonobstructive hypertrophic cardiomyopathy (HCM) and severe mitral valve regurgitation (MR) with transcatheter edge-to-edge repair (TEER) are rare. Herein, we present the case of a 68-year-old Chinese man with nonobstructive HCM admitted to our hospital with dyspnoea [New York Heart Association (NYHA) functional Class IV]. Transthoracic echocardiography indicated severe MR in addition to asymmetric hypertrophy of the left ventricle. Despite administering maximal medical therapy for heart failure, the symptoms were not alleviated; because of the high risk of open surgery, TEER was performed for MR. After 4 months of follow-up, the patient showed a significant improvement in symptoms. Herein, we also discuss and review the pathophysiology and treatment strategies for HCM patients with heart failure.

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Cite This Study

Zeng et al. (2023) conducted a case report in Nonobstructive hypertrophic cardiomyopathy with severe mitral valve regurgitation (n=1). Transcatheter edge-to-edge repair (TEER) with MitraClip was evaluated on Symptomatic improvement and reduction in mitral regurgitation severity. Transcatheter edge-to-edge repair with MitraClip reduced mitral regurgitation severity from severe to mild and improved symptoms from NYHA Class IV to Class II at 4 months.

synapsesocial.com/papers/6a5ebaed7279e6e036d943fa https://doi.org/10.1002/ehf2.14291