Acute Left Ventricular Dysfunction After Mitral Transcatheter Edge-to-Edge Repair

Figures

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  Figure 1. Baseline 12-Lead Electrocardiogram Electrocardiogram showing atrial fibrillation, with an average ventricular rate of 73 beats/min and no significant repolarization abnormalities.

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  Figure 2. Pre- and Postprocedural Echocardiography (A) TEE midesophageal long-axis view showing flail of the posterior leaflet (asterisk) due to chordal rupture, with preserved anterior leaflet. (B) Three-dimensional TEE atrial view confirming flail of the posterior leaflet (asterisk). (C) TTE apical 4-chamber view and (D) TEE midesophageal long-axis view with color Doppler demonstrating severe eccentric mitral regurgitation directed toward the interatrial septum. (E and F) X-plane TEE view after implantation of 2 MitraClip XTW devices showing marked reduction of mitral regurgitation. AL = anterior mitral leaflet; AO = aorta; LA = left atrium; LV = left ventricle; PL = posterior mitral leaflet; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography.

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  Figure 3. Echocardiographic Findings in the Intensive Care Unit TTE apical 4-chamber views in (A) diastole and (B) systole showing new-onset LV systolic dysfunction with reduced contractility of the apical and midsegments (red arrows) and compensatory basal hypercontractility (green arrows). Apical 2-chamber views in (C) diastole and (D) systole confirming mid-to-apical dysfunction (red arrows). (E and F) Apical 3-chamber views demonstrating the same pattern, with basal segments preserved. RA = right atrium; RV = right ventricle; other abbreviations as in Figure 2.

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  Figure 4. Postprocedural 12-Lead Electrocardiogram Electrocardiogram on postprocedure day 1 showed new, broad-based T-wave inversions across the anterior and inferior leads, with QTc prolongation (470 ms).

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  Figure 5. Coronary Angiography After LV Dysfunction Onset Coronary angiography demonstrated no significant stenosis of the epicardial coronary arteries (left anterior descending, left circumflex, or right coronary arteries). LV = left ventricular.

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  Figure 6. Follow-Up Echocardiography on Day 7 After M-TEER Showing Complete Recovery of LV Systolic Function (A and B) Apical 4-chamber views, (C and D) 2-chamber views, and (E and F) apical long-axis views demonstrating normalization of segmental contractility, with homogeneous systolic thickening across the LV walls. M-TEER = mitral transcatheter edge-to-edge repair; other abbreviations as in Figure 2 and 3.

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  Visual Summary. Acute LV Dysfunction Complicating M-TEER The sequence illustrates baseline status, abrupt LV failure after clip deployment, diagnostic differentiation between afterload mismatch and Takotsubo syndrome, targeted therapeutic management, and full recovery. Careful distinction between afterload mismatch and Takotsubo syndrome is essential, as it may influence both acute management and long-term prognosis. ARB = angiotensin receptor blocker; ECG = electrocardiogram; HF = heart failure; LA = left atrium; LV = left ventricle; LVEF = left ventricular ejection fraction; MR = mitral regurgitation; M-TEER = mitral transcatheter edge-to-edge repair; NTP = sodium nitroprusside; RA = right atrium; RV = right ventricle.