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Hypertrophic cardiomyopathy (HCM) can be associated with abnormalities of the mitral valve (MV) apparatus, left ventricular outflow tract obstruction (LVOTO) and mitral regurgitation (MR). Therapies for symptomatic patients include septal myomectomy (SM) or alcohol septal ablation (ASA) but subsets of patients are at prohibitive surgical risk or have unsuitable coronary anatomy. We report a series of patients treated with percutaneous mitral valve repair for symptomatic LVOTO and severe MR.
3 patients deemed to be prohibitive-risk for SM, or unsuitable for ASA (Table 1) by our institution’s Heart Team underwent transcatheter mitral valve repair with MitraClip®. Patients were selected based on specific 2D echo morphologic criteria (relatively elongated MV leaflets with systolic anterior motion (SAM), pre-procedural dobutamine stress transesophageal echocardiogram documenting augmentation of SAM and MR).
There were no procedural complications. All patients achieved echocardiographic and clinical improvement with resolution of LVOTO and MR, and significant improvement in functional capacity (Table 1, Figure 1).
|Age/ Gender (Limiting Co-morbidity)||Septal Wall Thickness (mm)||LVOT gradient (mm Hg) pre → post clip deployment||NYHA Class pre → post clip deployment||MR Grade pre → post clip deployment||Mitral Valve Gradient post clip (mm Hg)/ # of clips|
|76 Male (Parkinson’s disease)||20 mm||74 mm Hg → 13 mm Hg||III → I||IV → I||5 mm Hg (2 clips)|
|45 Male (Morbid Obesity; BMI 68 kg/m2)||23 mm||85 mm Hg → 12 mm Hg||IV → III||IV → I||4 mm Hg (1 clip)|
|81 Female (Frailty)||14 mm||130 mm Hg → 10 mm Hg||III → I||IV → I||4 mm Hg (1 clip)|
Percutaneous mitral valve repair using MitraClip® is an effective treatment strategy for selected high-risk patients with symptomatic LVOTO and MR secondary to SAM.
STRUCTURAL: Alcohol Septal Ablation/HOCM