Baylor University Medical Center Proceedings April 2017 - 227

from the right atrium. A single MitraClip was successfully placed across
the A2-P2 leaﬂets of the mitral valve.
Conﬁrmation of correct placement
was obtained via concurrent transesophageal echocardiography, with
reduction of the MR from severe
to mild (Figure 2). The patient was
seen in the clinic 6 months after the
procedure and was doing well, with
improvement in his symptoms and
functional status. A repeat echocardiogram showed sustained reduction
of the MR with the MitraClip.

DISCUSSION
Our case highlights the potential role for the MitraClip device
in treating severe MR in adult cardiac transplant patients who are at
high risk for mitral valve surgery. As
the MitraClip is a relatively novel device, there is limited data for its use
in cardiac transplant recipients. Our
review revealed two other reported
cases in which the MitraClip device
was used to treat MR in a cardiac
Figure 2. Intra- and postprocedure transesophageal echocardiograms showing (a, b) 3-dimensional positioning of transplant patient. Ferraro et al (4)
reported a patient who presented
the MitraClip and (c, d) successful reduction from severe to mild mitral valve regurgitation.
almost 20 years posttransplantation
with severe degenerative MR. He underwent successful placefailure. He had a prolonged postoperative course complicated
ment of two MitraClips with reduction from severe to mild MR.
by primary graft dysfunction, respiratory failure requiring traIorio et al (5) reported a patient who presented approximately
cheostomy, renal failure, and malnutrition. After an extended
1 year posttransplantation with severe MR secondary to a prohospital and rehabilitation stay, he did make signiﬁcant funclapsed leaﬂet and failure of adequate coaptation. Their patient
tional recovery on goal-directed medical therapy. Six months
also had successful reduction of his MR after MitraClip placeafter transplantation, he developed symptoms concerning of
ment. The MitraClip may be a feasible option for post-cardiac
heart failure. Acute cellular rejection was ruled out. A repeat
transplant patients with severe MR who are at high surgical risk.
echocardiogram showed mild to moderately depressed systolic
function (stable posttransplant) and severe functional MR (vena
1. Cavero MA, Pulpón LA, Rubio JA, Burgos R, Lozano I, Moreu J, Salas C.
contracta, 0.7 cm; proximal isovelocity surface area, 0.8 cm;
Mitral valve replacement in a heart transplant recipient with iatrogenic
eﬀective regurgitant oriﬁce area, 0.3 cm2; systemic blunting of
mitral regurgitation. Ann Thorac Surg 1996;61(5):1530-1532.
pulmonary venous ﬂow) due to a retracted posterior leaﬂet and
2. Wijburg ER, Balk AH, van Herwerden LA. Double valve repair in a
failure to coapt adequately (Figure 1).
transplanted heart. J Thorac Cardiovasc Surg 1998;115(1):250-251.
Given his medical comorbidities, poor functional status, and
3. Wigﬁeld CH, Lewis A, Parry G, Dark JH. Mitral valve dysfunction and
repair following orthotopic heart transplantation: a case report. Transplant
need for another sternotomy, he was deemed to be a high-risk
Proc 2008;40(5):1796-1797.
surgical candidate. The decision was made for him to undergo
4. Ferraro P, Biondi-Zoccai G, Giordano A. Transcatheter mitral valve retreatment with a MitraClip. The procedure was performed
pair with MitraClip for signiﬁcant mitral regurgitation long after heart
using both ﬂuoroscopy and 3-dimensional transesophageal
transplantion. Catheter Cardiovasc Interv 2016;88(1):144-149.
guidance. The standard right femoral venous approach was
5. Iorio A, Di Nora C, Abate E, Pinamonti B, Rakar S, Vitrella G, Tursi V,
Livi U, Salvi A, Singara G. MitraClip after heart transplantation: a case
used to gain access for the MitraClip apparatus. A transseptal
report. Int J Cardiol 2015;196:143-144.
puncture was performed to gain access into the left atrium

April 2017

Use of a MitraClip for severe mitral regurgitation in a cardiac transplant patient

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017