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The use of MitraClip to prevent posttranscatheter aortic valve replacement left ventricular “suicide”
Author(s) -
Bode Michael F.,
Ahmed Andaleeb A.,
Baron Suzanne J.,
Labib Sherif B.,
Gadey Gautam
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29100
Subject(s) - medicine , cardiology , alcohol septal ablation , mitraclip , ventricular outflow tract , aortic valve , afterload , hemodynamics , ventricular outflow tract obstruction , stenosis , right coronary artery , valve replacement , myocardial infarction , mitral regurgitation , mitral valve , hypertrophic cardiomyopathy , obstructive cardiomyopathy , coronary angiography
Patients with concomitant severe aortic stenosis (AS) and left ventricular outflow tract (LVOT) obstruction undergoing transcatheter aortic valve replacement (TAVR) are at risk for hemodynamic collapse due to a sudden decrease in afterload causing worsening LVOT obstruction. We present a case of an 88‐year‐old female with symptomatic, severe AS, and LVOT obstruction with systolic anterior motion (SAM) of the mitral leaflet in whom alcohol septal ablation was contraindicated secondary to a chronic total occlusion of the right coronary artery that filled retrograde via septal collaterals. MitraClip at the time of TAVR was successfully performed to treat SAM with subsequent stabilization of LVOT gradients despite treatment of the patient's AS. This novel approach may represent a feasible option to prevent hemodynamic complications after TAVR in patients with significant LVOT obstruction secondary to SAM and AS.