Use of MitraClip for Postmyocardial Infarction Mitral Regurgitation Secondary to Papillary Muscle Dysfunction

Figure 1. Electrocardiogram (EKG) showed finding suggestive of NSTEMI.

Figure 2. Chest X-ray showing pulmonary edema.

Figure 3. Echocardiography (ECHO) showed partial disruption of medial papillary muscle with severely flail posterior mitral valve (MV) leaflet and severe mitral regurgitation (MR).

Figure 4. Flail motion due to rupture of the posteromedial papillary muscle head. There is severe regurgitation, directed eccentrically.

Figure 5. Femoral vein was accessed using ultrasound guidance and transseptal puncture was performed using intraoperative transesophageal echocardiography (ECHO). This was then followed by prepping the MitraClip using standard technique and positioning it across the interatrial septum and above the atrial valve. For this procedure, two clips were used, one was on the posterior segment P2 and just beside it to cinch up P2 and A2, and the second one for P2 and P1 laterally. Once the resulting mitral regurgitation (MR) reduction was regarded adequate, clips were deployed.

Figure 6. Intraoperative transesophageal echocardiography (ECHO).