There have been only a few reported cases of patients with infective endocarditis in the region of the MitraClip [9,10]. The exact incidence of endocarditis in patients who underwent TMVR remains to be quantified because of its novelty and the rarity of infective endocarditis following this procedure [9,10]. Our patient had newly diagnosed end stage renal disease for which she had outpatient dialysis through a chronic indwelling venous catheter.
Like most reported cases of MitraClips complicated by infective endocarditis, our patient presented with fever and non-specific symptoms like progressive weakness; she was, eventually, found to have Staphylococcus aureus bacteremia.
Percutaneous Mitral Valve Repair
A transesophageal echocardiogram showed vegetations in the region of the MitraClip which confirmed the diagnosis. Endocarditis can be a major but rare complication of cardiac device implantation; for example, in patients with pacemakers and defibrillators, the rate of endocarditis is 0.
The exact risk of endocarditis in MitraClip patients with ESRD with or without chronic indwelling catheters remains to be determined. This is the first reported case of a patient with a chronic indwelling catheter who developed endocarditis on the MitraClip. As this procedure becomes more frequently used for treatment of severe MR in select patients, the incidence of endocarditis, particularly in high risk subsets, such as dialysis patients, bears monitoring . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Special Issues Frequently Asked Questions. Links Advanced knowledge sharing through global community… Read More. Take a look at the Recent articles. Keywords Infective endocarditis, MitraClip Introduction Mitral regurgitation MR or incompetence is a condition in which there is back flow of blood into the left atrium during systole as a result of incomplete apposition of the mitral valve leaflets.
Case-Report Our patient was a year-old female who presented to the hospital with progressive fatigue, fever, and dislodged dialysis catheter. The red arrows point to the vegetations on the Mitraclip Figure 3.
The picture shows severe MR on the color doppler Discussion For a select group of patients with severe MR who are at extreme risk for surgery due to advanced age, multiple comorbidities or severely reduced ejection fraction, TMVR with the MitraClip is an emerging alternative option . J Thorac Dis 6: SS Lancet J Am Coll Cardiol Eur Heart J Am J Cardiol Med Devices Auckl 9: J Thorac Dis 7: MitraClip Procedural Echocardiography.
Transseptal Puncture. Venous Access Management. Situational Steering Techniques. MitraClip: Basic Degenerative Case.
Satya S. Shreenivas, Howard C. Case Example: Two Clips. Ehrin J. Infective Endocarditis Associated with the MitraClip. Armstrong, Reginald Low, Jason Rogers. Martin J. Swaans, Jan A. Van der Heyden. Therefore, the effect of learning curve and co-operation between heart team members could impact on the clinical outcome in terms of MR reduction and complication rates.
- Rameaus Neffe (German Edition).
- Khung Keong Yeo (Editor of Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair).
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Download original. Of note, during the implantation of MitraClip, there is often a compromise between complete reductions of MR and resultant mitral stenosis by placing further clips. Several studies have reported that in these patients, significant improvement in symptoms can still be achieved despite a complete resolution of MR.
Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair | E-bok | Ellibs E-bokhandel
At one-year, nine patients experienced single leaflet device attachment but no embolisation was observed. From one to five years follow-up, no further single device attachment or embolisation was observed. Survival rates at five years were similar in the Mitraclip and surgical groups There was a concern on the need of re-operation for the Mitraclip patients. Mitraclip patients had comparable stability of mitral annular dimensions at five years compared to baseline 4. Improved clinical performance in the six-minute walking test have also been reported.
Functional Mitral Valve Regurgitation Ischaemic MR is characterised by restrictive mitral leaflet mobility due to dyskinesia or akinesia of the ventricular wall involving one or both papillary muscles, thus, extending the distance between the ventricular wall and the leaflets. The posterior papillary muscle is the most frequently affected. FMR is associated with a poor prognosis in heart failure patients with post-ischaemic or idiopathic dilated cardiomyopathy.
Surgical Treatment Historically, the surgical approach to patients with FMR was to perform MV replacement, but it had a high impact on LV systolic function and exerted high mortality rates. Techniques of MV replacement, such as prosthesis implantation with preservation of the subvalvular apparatus, and prosthesis implantation with preservation of one or both leaflets usually posterior have evolved to improve the long-term haemodynamic function and clinical status of these patients 38 Replacement should be reserved for cases of acute papillary muscle rupture in relation to acute myocardial infarction.
Acker et al. At 12 months, the rate of death was Patient selection for repair is crucial. When the pre-operative clinical and echocardiographic data suggest that annuloplasty alone is unlikely to be successful and durable, additional surgical procedures should be used to enhance the effectiveness of MV repair.
Since FMR exerts high mortality and high incidence of recurrence of MR after repair, several alternative treatments have been proposed.
Mitraclip patients had comparable stability of mitral annular dimensions at five years compared to baseline 3. Taramasso et al. Procedural success was At 12 months, EF was Actuarial survival at three years was