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

Abstract

The EVEREST II trial investigated the MitraClip (Abbott Vascular, Menlo Park, CA) in patients with severe mitral regurgitation (MR) undergoing surgical procedures. Although mitral stenosis was not reported in this cohort, this trial excluded patients receiving dialysis. We report a case of a 43-year-old HIV-positive, dialysis-dependent patient with nonischemic cardiomyopathy and severe MR, who was considered at high operative risk because of frailty. She was treated with a MitraClip as part of the REALISM high-risk registry. Her symptomatic MR improved but severe symptomatic mitral stenosis developed 28 months after the MitraClip procedure. At that point, she was felt to be a better operative candidate but required open mitral valve replacement. Pathologic examination demonstrated significant calcification of the leaflets around the MitraClip devices.

Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1

Transesophageal echocardiography (TEE) at time of operation 28 months after MitraClip device implantation, demonstrating severe calcific mitral stenosis.

Fig 2

(A) Intraoperative photograph of severely stenotic and calcified mitral valve 28 months after placement of 2 MitraClip devices for symptomatic MR. (B) Side view of Mitra-Clip after extraction, with adherent calcified leaflets. Suture marks posterior attachment. Both devices had similar calcification to the leaflets and were difficult to extract.