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TEER Beyond Contraindication: Resolving Recurrent Cerebral Infarction in a Patient With Degenerative Mitral
Minghao Ma1, Xinghua Gu2, Wenzhi Pan3
1Second Clinical Medical School, Shandong University, Jinan, China.
Background:
Degenerative mitral regurgitation is a common valvular heart disease, with transcatheter edge-to-edge repair an alternative option for high-risk patients. Nonbacterial thrombotic endocarditis, a rare condition with sterile valvular excrescences, often causes cerebrovascular embolism and is thought to be the contraindication to transcatheter edge-to-edge repair.
Case Summary:
A 52-year-old man with multiple comorbidities presented to the hospital with recurrent cerebral infarctions, massive mitral regurgitation and nonbacterial thrombotic endocarditis. Transcatheter edge-to-edge repair and carotid embolic protection device implantation were performed to ameliorate mitral regurgitation, avoid the recurrence of cerebral embolism and delay the time for surgical valve replacement.
Discussion:
The patient's history of antineutrophil cytoplasmic antibody-associated vasculitis, nephritis, and glucocorticoid use made surgical treatment risky. Transcatheter edge-to-edge repair is feasible for severe degenerative mitral regurgitation with nonbacterial thrombotic endocarditis, especially with carotid protection, which reduces embolism risk and postpones valve replacement.
Take-Home Message:
This case demonstrates the feasibility of transcatheter edge-to-edge repair with concurrent nonbacterial thrombotic endocarditis and recurrent cerebral infarction when paired with carotid embolic protection.
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