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Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

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CASE20191029_013
STRUCTURAL HEART DISEASE - Valvular Intervention: Mitral or Tricuspid
A Case of Transcatheter Edge-to-Edge Mitral Valve Repair for Severe Mitral Regurgitation with Rheumatic Mitral Stenosis
Koya Okabe1, Shunsuke Kubo1, Keigo Miyajima1, Katsuya Miura1, Hidewo Amano1, Takeshi Maruo1, Kazushige Kadota1
Kurashiki Central Hospital, Japan1,
[Clinical Information]
- Patient initials or identifier number:
TA
-Relevant clinical history and physical exam:
A 90-year-old woman has been hospitalized for congestive heart failure due to severe mitral regurgitation (MR) multiple times. After the heart failure treatment, she had dyspnea at rest with New York Hear Association class IV)
-Relevant test results prior to catheterization:
Transthoracic echocardiography (TTE) showed preservedleft ventricular function and severe MR (regurgitation volume = 47ml, effectiveregurgitant orifice area = 0.48 cm2) with pulmonary hypertension.Transesophageal echocardiography showed P1 and P2 prolapse in P1 and P2 leafletwith rheumatic degeneration. Preprocedural mitral valve area was 3.9cm2and mean mitral valve pressure gradient [MVPG] was 7.2mmHg suggesting the riskof mitral stenosis by clipping.
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- Relevant catheterization findings:
[Interventional Management]
- Procedural step:
After the heart-team discussion, we performed transcatheter edge-to-edge mitral valve repair with the MitraClip device due to her age and frailty. The initial goal of this procedure was moderate MR with slightly increased mitral valve mean pressure gradient.After transseptal puncture, the left atrialv wave pressure was 61 mmHg. We grasped the A1/P1 leaflet by the 1st clip, and MRdecreased severe to moderate with 4mmHg of mean MVPG. We deployed the clip, butresidual MR was eccentric anteriorly due to residual P2 prolapse. Left atrial vwave pressure remained 27 mmHg, so we decided to put the 2nd clip to completelycover the residual prolapse. After the second clip deployment for A2/P2 are, MRdecreased moderate to trivial. Mean MVPG increased to 6 mmHg. But, this MVPG seemednot to be clinically significant due to the frailty of this patient. Therefore,we decided to deploy the 2nd clip. The final MR grade was trivial and the leftatrial v wave pressure decreased to 21 mmHg. After the procedure, her symptomsdisappeared (New York Hear Association class I). She was discharged to recuperationhospital on postoperative day 5 in stable condition. One-month follow-up TTEdemonstrated mild MR and she was free from heart failure hospitalization 1 yearafter procedure.
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- Case Summary:
This patient had challenging anatomy of the MitraClip including rheumatic leaflet degeneration and baseline high mean MVPG. Despite the risk of mitral stenosis, we successfully implanted two clips resulting trivial MR with accepted mean MVPG. When we try to perform the MitraClip therapy for the challenging mitral valve anatomy, optimal procedural endpoint and hemodynamic should be assessed considering each patient¡¯s age, frailty, and daily activities.
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