February 2, 2016European Heart Journal4 citations
Catheter-based complete “Alfieri-Stich” via interventional annuloplasty and edge-to-edge repair for degenerative mitral regurgitation
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Key Result
Combined interventional annuloplasty with the Carillon-device and edge-to-edge repair with MitraClip reduced MV annular diameters but had no relevant effect on MR severity in an 84-year-old female.
Study Design
Type
Case Report (n=1)
Structured PICO
Does a combined interventional annuloplasty and edge-to-edge repair improve severe degenerative mitral regurgitation in an elderly patient?
P
Population
An 84-year-old female with severe degenerative mitral regurgitation and chronic dyspnoea undergoing a combined interventional annuloplasty and edge-to-edge repair.
I
Intervention
Combined interventional approach mimicking the Alfieri technique: interventional annuloplasty with the Carillon-device and transcatheter mitral valve repair (TMVR) with the MitraClip-system.
O
Outcome
Reduction of mitral valve annular diameters and mitral regurgitation severity.surrogate
A combined catheter-based 'Alfieri-Stich' approach using interventional annuloplasty and edge-to-edge repair is technically feasible for treating severe degenerative mitral regurgitation.
Abstract
An 84-year-old female (EuroScore II: 9.64%) presented with chronic dyspnoea NYHA functional class III and acute peripheral oedema. Three-dimensional transoesophageal echocardiography (3DTEE) showed severe degenerative mitral regurgitation (MR) (PISA 0.8 cm, vena contracta width 0.5 cm, EROA 0.28 cm2, and regurgitant volume 45 mL/beat) due to a posterior mitral valve (MV) leaflet prolapse (PML, A2/P2-region) and left atrial enlargement (volume 115 mL, volume index 82 mL/m², area 31.4 cm2, anterior–posterior diameter 4.0 cm, latero-medial diameter 4.3 cm) (Panels A and B). Heart-Team decision was made on a combined interventional approach mimicking the original Alfieri technique, which showed best results when combining annuloplasty and edge-to-edge plication of the MV leaflets, including interventional annuloplasty with the Carillon-device and TMVR with the MitraClip-system. Detailed information on the Carillon-device and the MitraClip-technique have been published earlier. 3D TEE confirmed Carillon-device placement on the posterior circumference of the MV annulus with reduction of MV annular diameters (anterior–posterior diameter 3.8 cm Δ0.2 cm, latero-medial diameter 4.0 cm Δ0.3 cm) and no relevant effect on MR severity (Panels C and D).