Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2015; 7(11): 817-821
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.817
Catheter-based intervention for symptomatic patient with severe mitral regurgitation and very poor left ventricular systolic function - Safe but no room for complacency
Poay Huan Loh, Christos V Bourantas, Pak Hei Chan, Nikolaj Ihlemann, Fin Gustafsson, Andrew L Clark, Susanna Price, Carlo Di Mario, Neil Moat, Farqad Alamgir, Rodrigo Estevez-Loureiro, Lars Søndergaard, Olaf Franzen
Poay Huan Loh, National University Heart Center Singapore, Singapore 169856, Singapore
Christos V Bourantas, University College London, London W6 8LN, United Kingdom
Pak Hei Chan, Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
Nikolaj Ihlemann, Fin Gustafsson, Lars Søndergaard, Department of Cardiology, Rigshospitalet University Hospital, DK-2300 Copenhagen, Denmark
Andrew L Clark, Hull and East Yorkshire Hospitals NHS Trust, Cottingham HU6 7RX, United Kingdom
Susanna Price, Carlo Di Mario, Neil Moat, NIHR Cardiovascular BRU, Royal Brompton Hospital and Imperial College, London W6 8LN, United Kingdom
Farqad Alamgir, King Abdulaziz Medical Center, Jeddah 21589, Saudi Arabia
Rodrigo Estevez-Loureiro, Complejo Asistencial Universitario de Leon, 24071 Leon, Spain
Olaf Franzen, Klinik Im Park, 8091 Zurich, Switzerland
Author contributions: Loh PH, Alamgir F, Søndergaard L and Franzen O involved in the conception and design of the report; Loh PH, Bourantas CV and Chan PH collected and analysed the patients’ clinical data; all co-authors involved in interpretation of clinical and hemodynamic data for the treatment of patients and preparation of this report; Loh PH, Clark AL, Price S and Franzen O wrote the report; all co-authors read and approved the final report.
Institutional review board statement: This case series is approved by the Institutional Review Board of Rigshospitalet University Hospital (Denmark), Hull and East Yorkshire Hospitals NHS Trust (United Kingdom) and the Royal Brompton Hospital (United Kingdom) where the patients were treated.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: Dr. Olaf Franzen has received speaker, proctorship and advisor honoraria and research grant from Abbott (IL, United States). Other authors have no potential conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Olaf Franzen, MD, Klinik Im Park, HerzGefässZentrum, Seestrasse, 247, 8091 Zurich, Switzerland. conpro.franzen@gmail.com
Telephone: +41-44-2092015 Fax: +41-44-2092028
Received: January 29, 2015
Peer-review started: January 29, 2015
First decision: May 13, 2015
Revised: August 27, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 26, 2015
Processing time: 304 Days and 15.4 Hours
Abstract

Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation (MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous MitraClip® can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures.

Keywords: Mitral regurgitation; Mitral valve; Left ventricular systolic dysfunction; Chronic heart failure; MitraClip; Percutaneous

Core tip: We described three patients with severe mitral regurgitation and very poor left ventricular systolic function undergoing percutaneous MitraClip treatment. These patients experienced haemodynamic instability peri-procedurally immediately upon reduction of their mitral regurgitation. These patients shared a few features such as right ventricular dysfunction and pulmonary hypertension which may help to identify those who may develop such peri-procedural haemodynamic compromise. Our cases highlight that although MitraClip is generally a safe procedure, there should not be complacency especially when treating patients with very poor left ventricular function. Extreme caution and vigilance should be exercised when treating such patients.