Killing two birds with one stone—MitraClip for flail P2 and systolic anterior motion of mitral valve: a case report

Figures

• 

  Figure 1. Electrocardiogram showing atrial fibrillation as well as left ventricular hypertrophy with strain.

• 

  Figure 2. (A) Parasternal long-axis view showing severe left ventricular hypertrophy and systolic anterior motion of the mitral valve. (B) Late-peaking left ventricular outflow tract (LVOT) gradient of 76 mmHg. (C) 3D and (D) 2D transoesophageal echocardiographic mid-oesophageal 4-chamber views showing P2 flail. (E) LVOT view showing severe mitral regurgitation and flow acceleration across the LVOT.

• 

  Figure 3. First clip was placed centrally over the flail segment with reduction of the mitral regurgitation grade from 4+ to 2+. Transoesophageal echocardiographic views showing residual posteriorly directed mitral regurgitation at the A1 segment, lateral to the first clip, and was systolic anterior motion-related.

• 

  Figure 4. (A) Fluoroscopic view showing second clip deployed lateral to the first clip. Transoesophageal echocardiographic images showing (B) residual 1–2+ mitral regurgitation in the intercommissural view, and (C) reduction of systolic anterior motion-related mitral regurgitation in the left ventricular outflow tract view. (D) The left ventricular outflow tract peak pressure gradient was reduced to 33 mmHg.