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Late calcific mitral stenosis after MitraClip procedure in a dialysis-dependent patient

Nicolas H Pope1, Scott Lim, Gorav Ailawadi

  • 1Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.

The Annals of Thoracic Surgery
|April 24, 2013
PubMed

Insights

The MitraClip device effectively treated severe mitral regurgitation in a high-risk patient. However, it later led to severe mitral stenosis, necessitating valve replacement.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • The EVEREST II trial evaluated the MitraClip for severe mitral regurgitation (MR), excluding dialysis patients.
  • Severe MR poses significant risks, especially in frail patients with comorbidities like HIV and nonischemic cardiomyopathy.

Observation:

  • A case report details a 43-year-old, HIV-positive, dialysis-dependent patient with severe MR and cardiomyopathy treated with MitraClip.
  • The patient, deemed high-risk for surgery, showed initial improvement in MR symptoms post-MitraClip implantation.

Findings:

  • Twenty-eight months after MitraClip implantation, the patient developed severe symptomatic mitral stenosis.
  • Surgical mitral valve replacement was ultimately required, with pathologic examination revealing significant calcification around the MitraClip devices.

Implications:

  • MitraClip may be a viable option for select high-risk patients with severe MR.
  • Long-term complications, including device-related calcification and subsequent mitral stenosis, should be monitored in patients treated with MitraClip, particularly those with complex medical histories.

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