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MitraClip-induced systolic anterior motion complicated by pericardial effusion: A case report
Amos Levi1,2, Alexander Sagie1,2, Ran Kornowski1,2
1Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel.
Abstract:
Systolic anterior motion (SAM) of the anterior mitral leaflet is a well reported complication of surgical mitral valve repair (MVR). In the current report, we present a case of SAM with left ventricular outflow tract obstruction (LVOTO) which occurred after transcatheter mitral valve repair (TMVR) using the MitraClip device. LVOTO was caused by the combination of protrusion of the MitraClip device into the LVOT and underfilling of the left ventricle due to pericardial effusion and atrial fibrillation. Rapid clinical resolution and marked decline in LVOT pressure gradient occurred following surgical drainage and windowing of the pericardium. We conclude that SAM and LVOTO could occur after TMVR. Seeking and addressing reversible aggravators of LVOTO including pericardial effusion is essential and could potentially make the difference between a successful procedure and a failed one. © 2016 Wiley Periodicals, Inc.
Insights
Systolic anterior motion (SAM) and left ventricular outflow tract obstruction (LVOTO) can occur after transcatheter mitral valve repair (TMVR). Addressing reversible causes like pericardial effusion is crucial for successful outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Systolic anterior motion (SAM) of the anterior mitral leaflet is a known complication following surgical mitral valve repair (MVR).
- Transcatheter mitral valve repair (TMVR) using devices like MitraClip offers a less invasive alternative for mitral valve disease.
Observation:
- This report details a rare case of SAM causing left ventricular outflow tract obstruction (LVOTO) after TMVR with a MitraClip device.
- The LVOTO was attributed to MitraClip protrusion into the LVOT, compounded by left ventricular underfilling due to pericardial effusion and atrial fibrillation.
Findings:
- Clinical resolution of LVOTO was achieved rapidly following pericardiocentesis and pericardial window creation.
- The pressure gradient across the LVOT significantly decreased after addressing the pericardial effusion.
Implications:
- Systolic anterior motion and LVOTO are potential complications following TMVR, not exclusive to surgical MVR.
- Identifying and managing reversible factors, such as pericardial effusion, is critical for optimizing TMVR outcomes and preventing procedural failure.
