Secondary Mitral Regurgitation Vera H. Rigolin, MD, FASE Vice-President, American Society of Echocardiography Professor of Medicine Northwestern University Bluhm Cardiovascular Institute Medical Director, Echocardiography Laboratory Northwestern Memorial Hospital Chicago, IL USA
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Secondary Mitral Regurgitation
Vera H. Rigolin, MD, FASEVice-President, American Society of Echocardiography
murmur at apex• Abd: Soft, NT. No HSM or ascites• Ext: No edema
Transthoracic Echo
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MV Annulus=4.9 cmCoapt depth=1.4 cm
LVEDV=193 mlLVESV=130 mlEF=33%
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EROA = 0.24 cm2 RV=47 ml
VC=0.8 cm
E=92 cm/sec
Organic MR
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
Functional MR
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
• What can we offer this patient?Medical therapy?Surgery?Mitra Clip?
COAPT TRIAL
• A clinical trial designed to study the safety and effectiveness of the MitraClip® device in heart failure patients who have functional mitral regurgitation (MR) and are not appropriate for mitral value surgery.
• Patients randomly assigned to a Device Group or Control Group
Followup
• Addition of lisinopril 10 mg daily• PCI of PDA• 5 months later: c/o fatigue, SOB improved
Echo 5 months later
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LVEDV=184 mlLVESV=109 mlEF=40%
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Case 2• 67 yr old male with h/oMi (PDA) 1 yr prior• MI complicated by cardiogenic shock and MR• Improved with medical therapy• Recently admitted multiple times with
• Frailty: Incontinence, grip strength=20 (frail), 15 ft walk time=8.3 sec(frail)
• STS score=20%
Physical Exam
• BP=134/70, HR=62• Neck: JVP to jaw• Lungs: Difficult to hear due to tachypnea• Cor: RRR, 3/6 holosystolic murmur at apex• Abd: No HSM or ascites• Ext: 1+ edema
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MV Annulus=4.8 cmCoaptationdepth=1.2 cm
LVEDV=201 mlLVESV=134 mlEF=33%
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Radius=0.8 cm
VC=0.6 cm
EROA=0.23 cm2RV= 47 ml
E=90 cm/s
What Can We Offer This Patient?
TEE During Mitra-Clip
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Post Mitra Clip
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Post Mitra Clip
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Follow up Echo 11 Months Later
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Baker – TTE 7/16/15 View 2
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LVEDV= 217 mlLVESV=171 mlEF=28%
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Follow up
• Dyspnea improved but still in class IV HF• Second mitra clip procedure unsuccessful• Pt died of progressive heart failure one year
after first MitraClip
Thank You
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Thank you for your time and attention and I’d be happy to take any questions at this time.