Late MitraClip Embolization
A New Cause of ST-Segment–Elevation Myocardial Infarction
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- cardiac surgical procedures
- mitral valve
- mitral valve insufficiency
- myocardial infarction
- shock, cardiogenic
- tachycardia, ventricular
Percutaneous edge-to-edge mitral valve repair using the MitraClip device (Abbott Vascular) is currently indicated for high-risk patients with symptomatic severe mitral valve regurgitation. The percutaneous approach, although inferior to surgical mitral valve repair, has an excellent safety profile. We report the first case of ST-segment–elevation myocardial infarction caused by late embolization of MitraClip to the right coronary ostium.
An 80-year-old gentleman with severe symptomatic mitral regurgitation and multiple cardiac risk factors including coronary artery disease, moderate aortic stenosis, atrial fibrillation, hypertension, and moderately reduced left ventricular systolic function underwent percutaneous mitral valve repair with 3 MitraClips at another medical center. The first clip was deployed in A2-P2 position with a 12 to 6 o’clock orientation, despite having difficulties grasping the posterior leaflet because of significant degree of flail (Movie I in the Data Supplement). Given a moderate residual regurgitation (Movie II in the Data Supplement), a second clip was placed just lateral to the first one. After full release of the second clip, there appeared to be a single leaflet attachment of both clips with one free clip attached to the anterior leaflet and one free clip attached to the posterior leaflet (Movie III in the Data Supplement …