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ARTICLE – MITRACLIPS
BY:
FOR:
The case of a 76-year-old man who came to our center due to anginal chest pain that started in
the previous 24 hours is presented. The electrocardiogram at that time showed waves of necrosis
located inferolaterally with ST elevation in these leads. Urgent coronary angiography was
performed, which demonstrated occlusion of the proximal circumflex artery and non-significant
irregularities in the rest of the arteries. In this situation, it was decided to treat the artery causing
the infarction. An 8 3/23mm Multilink stent (Abbott Vascular; Santa Clara, California, United
States) was implanted, with optimal angiographic results. In the subsequent 24 hours, the patient
suffered two episodes of acute pulmonary edema that were controlled with diuretic and
vasodilator treatment, without the need for amines or balloon pump. Subsequently, the patient
maintained signs of residual pulmonary congestion. A transthoracic echocardiogram at this time
showed severe mitral regurgitation (MR) due to restriction of the posterior leaflet related to
ischemic involvement of the posteromedial papillary muscle. 12 hours after this event, the patient
suffered an acute stroke in the territory of the left middle cerebral artery, from which he
recovered ad integrum in hours. With a view to correcting the valve disease, the case was
presented to the surgeons, who dismissed the intervention due to its high risk (Society of Thoracic
Surgeons [STS] score: mortality, 6.7%; logistic EuroScore, 29.1%). Given the improbable good
evolution of the patient without correcting the valvular complication, mitral repair was decided
using the MitraClip® device (Abbott Vascular). Transesophageal echocardiography was previously
performed, which revealed severe MR with regurgitant jet located in segments A2-P2, although
with a certain medial component (A3-P3).
The procedure was performed under general anesthesia and guided by transesophageal
echocardiography. After grasping both leaflets in position A2-P2, a significant decrease in
regurgitation was found, although moderate residual MR persisted in the area lateral to the
implanted clip. For this reason, a second clip was implanted lateral to the previous one, which
managed to reduce the MR to <1/4.
QUESTIONS
a. T A C
b. transesophageal echocardiography
c. angiography
a. Papillary
b. trabecular
c. triceps
a. fifty%
b. 70%
c. 80%