A Case in Which Mitral Valve Replacement Was Performed for Recurrent Severe Mitral Regurgitation by Single Leaflet Device Attachment（SLDA）after MitraClip

Yuta Kitagata＊	Hiroshi Tsuneyoshi＊	Chikara Ueki＊
Ken Yamanaka＊	Masahiro Hirano

（Department of Cardiovascular Surgery, Shizuoka General Hospital＊, Shizuoka, Japan）

After a MitraClip was implanted for mitral regurgitation（MR), we experienced a case in which mitral valve replacement was performed for recurrent severe MR because of a detached MitraClip. The case was an 82-year-old woman. The MitraClip was implanted for severe MR and regurgitation was controlled to a mild level, but one month after the operation, symptoms of heart failure appeared, and single leaflet device attachment（SLDA）with severe MR was observed on the echocardiogram. As the heart failure symptoms recurred, surgical mitral valve replacement was performed. Because of severe kyphosis, the left atrial approach with a midline sternum incision made it difficult to achieve a good operative field and this was changed intraoperatively to a transseptal approach. The MitraClip was firmly fused with the anterior leaflet A2, so it was judged that removal of the clip was difficult and valve repair was impossible;it was thus decided to replace the valve. The mark of the MitraClip could be observed on the posterior leaflet, and it appeared to have been inserted for only about 1-2mm. A bioprosthetic valve was implanted, preserving the posterior leaflet. There were no problems in weaning the patient from cardiopulmonary bypass. The postoperative course was uneventful, and she was discharged on the 14th day after the operation. Valve repair is difficult in a case with a merged SLDA after insertion of a MitraClip, and valve replacement needs to be performed, so it is important to pay attention to the attachment of the MitraClip.

 

Jpn. J. Cardiovasc. Surg. 49:119-122（2020）

Keywords：MitraClip;SLDA;mitral regurgitation;mitral valve replacement