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Hendrik Martinus Willemsen, Ad van den Heuvel, Remco Schurer, Joost van Melle, Eshan Natour, Mitral cleft repair by mitraclipping, European Heart Journal, Volume 35, Issue 16, 21 April 2014, Page 1021, https://doi.org/10.1093/eurheartj/eht475
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We present a case of a 51-year-old male patient with severe mitral regurgitation and a dilated left ventricle with a poor function (LVEF 15%). The mitral regurgitation initially was considered to be due to annular dilatation and malcoaptation. Mitral surgery was considered too riskful. The patient was accepted for mitraclip treatment. In this procedure, a posterior leaflet cleft was objected with three-dimensional trans oesophagal echocardiography. The regurgitation orifice was located at the cleft location, and was the cause of mitral-insufficiency. Mitraclips are made to be placed perpendicular on the leaflets, and cannot be placed on a cleft, which is itself perpendicular on the mitral closure orifice. Because surgical edge-to-edge mitral repair has been successful in a mitral cleft, we decided to do likewise with mitral clips. The first mitraclip was placed posteromedial right along the cleft, but did not reduce the mitral-insufficiency enough. There was a reduction of the mitral-insufficiency in the cleft, but a new mitral-insufficiency emerged in the more anterolateral closure. A second mitraclip was placed close to the cleft on the anterolateral side in a symmetrical fashion. This resulted in two left ventricular inflow orifices, while in between the clips the cleft was closed. Near complete reduction of the mitral-insufficiency was achieved without significant mitral stenosis.
