First experience of the usage of a GORE CARDIOFORM S eptal O ccluder device for treatment of a significant residual commissural mitral regurgitation jet following a M itra C lip procedure

The MitraClip (Abbott Vascular, Santa Clara, CA) procedure has emerged as a safe and effective treatment option for treatment of selected patients with severe mitral regurgitation (MR) who are at high risk for surgery. Effective reduction of MR is important to ensure an optimal clinical outcome. We present here the first case report of a significant commissural leak after a MitraClip procedure treated with a GORE CARDIOFORM Septal Occluder device (WL Gore & Associates, Flagstaff, AZ). CASE REPORT: An 81-year-old male presented with symptomatic recurrent MR following a MitraClip procedure using two clips. After adding another clip, there was still a residual jet medially. We plugged the gap using 12-mm AMPLATZER Muscular VSD Occluder device (St. Jude Medical, Minneapolis, MN). MR was reduced but hemolysis occurred. We retrieved the VSD Occluder device to improve hemolysis, but the MR jet worsened to severe, so we placed a 30-mm GORE CARDIOFORM Septal Occluder device. The device was stable, the MR jet was reduced dramatically, and hemolysis was not observed. Materials of these devices are mesh fabric made from nitinol and polyester in a VSD Occluder device and expanded polytetrafluoroethylene in GORE CARDIOFORM Septal Occluder device. The difference between device materials affects flow pattern of residual jet and hemolysis. In conclusion, the patient's risk for hemolysis is potentially affected by the occluder or plug material. GORE CARDIOFORM is a feasible choice to reduce the risk of hemolysis in a selected patient.