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July 1, 2021European Heart Journal - Case ReportsOpen Access

A case report of transcatheter mitral valve repair in patient with severe acute mitral regurgitation, cardiogenic shock, and left atrial appendage thrombus as a rescue therapy: facing all enemies at once!

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Why the study?

TMVR as a rescue therapy with concurrent cerebral protection device use in a patient with acute ischaemic MR, cardiogenic shock, and left atrial appendage thrombus had not been reported.

Population

A 59-year-old female with acute severe MR, cardiogenic shock, and LAA thrombus

Comparison

TMVR with concurrent use of CPD as rescue therapy

Design

Case report

Authors

MAMhd Nawar AlachkarJSJörg SchröderRARüdiger Autschbach

Discussion

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Overview

Suggests feasibility of TMVR with CPD in acute ischaemic MR, shock and LAA thrombus; leaves open need for prospective validation.

Key Points

  • To evaluate the feasibility and safety of rescue transcatheter mitral valve repair combined with cerebral embolic protection in an inoperable patient presenting with acute severe mitral regurgitation, cardiogenic shock, and left atrial appendage thrombus.
  • Treated a 59-year-old female presenting with acute severe ischemic mitral regurgitation, electrical storm, cardiogenic shock, and left atrial appendage thrombus following subacute stent thrombosis.
  • Performed emergency transcatheter edge-to-edge mitral valve repair using the MitraClip system under concurrent cerebral embolic protection using the Sentinel device.
  • Achieved immediate hemodynamic stabilization and significant clinical improvement post-procedure without periprocedural complications.
  • Enabled successful hospital discharge with complete preservation of neurological function and no evident embolic sequelae.

Structured PICO

P
Population
1 patient (n=1), 59-year-old female with subacute lateral myocardial infarction, acute heart failure due to acute severe mitral regurgitation, left atrial appendage (LAA) thrombus, electrical storm, and cardiogenic shock.
I
Intervention
Transcatheter mitral valve repair (TMVR) using MitraClip with concurrent use of a cerebral protection device (CPD) (Sentinel) as a rescue therapy.
O
Outcome
Clinical and haemodynamic improvement and absence of neurological sequelae at discharge.

TMVR with concurrent use of a cerebral protection device may be a feasible rescue therapy for inoperable patients with cardiogenic shock from acute severe mitral regurgitation and concurrent LAA thrombus.

Cite This Study

Alachkar et al. (2021) studied this question.

synapsesocial.com/papers/6a952cdd2fdd6c151ff22844https://doi.org/10.1093/ehjcr/ytab266
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Management of giant left atrial thrombus late after transcatheter mitral valve-in-ring replacement using a transcatheter aortic valve: a case report2024 · 2 citations
  2. 2MITRACLIP TREATMENT FOR CARDIOGENIC SHOCK DUE TO ACUTE MITRAL REGURGITATION IN A PATIENT WITH POSTINFARCTION PAPILLARY MUSCLE RUPTURE2024
  3. 3Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation2020 · 99 citations
  4. 4Transcatheter Mitral Valve Repair in Acute and Critical Cardiac Conditions2023 · 6 citations
  5. 5Transcatheter Mitral Valve Replacement in a complex mitral annular calcification anatomy2025