Mitral valve repair: Infective endocarditis after MitralClip

Introduction: An increasing number of patients are treated by percutaneous mitral valve repair by the MitraClip device. The device was evaluated in an animal model prior to use in humans. A high infective endocarditis rate (2 out of 21 one pigs during life) was an important finding in this study (Luk et al, Cardiovascular Path 2009). We refer to a female patient with following endocarditis and acute mitral valve insufficiency after MitralClip. Finally the patient had to be treated successfully by surgical mitral valve procedure. Aims: At first the woman suffered from mitral valve incompetence in the clinical state of NYHA III-IV and was primarily treated successfully by MitralClip. Post interventional procedure the NYHA state immediately recovered to NYHA I. Residual permissive mitral valve incompetence I-II° was classified as an excellent result after MitralClip procedure. Five weeks later the patient felt weak, had fever and returned to NYHA IV again. The Echocardiography showed ruptured chordae and adherent material on the clip. No cerebral event has occurred so far. Based on the diagnosis of a mitral valve endocarditis after MitralClip with an acute mitral valve insufficiency urgent surgical procedure was required. The intraoperative findings showed an almost completely destroyed mitral valve. The Mitral Clip device performed perforations in the annulus of mitral valve and chordae were ruptured. Too little left native valve texture was insufficient for any techniques of mitral valve repair. For that reason there had to be a mitral valve replacement with a biological prosthesis. Perioperative course and 1-year follow-up was reported uneventful. Discussion: The risk of infective endocarditis after MitraClip has to be considered. Furthermore the risk of thrombotic adhesion attended by infective process has to be reconsidered. In view of the fact that the MitralClip device is a large foreign body in the hemodynmic centre of the valve, long term data regarding endocarditis and cerebral events have to be evaluated. A surgical repair, that was initially possible with ease, is not very likely after MitraClip endocarditis.