Cardiovascular Diseases and Cardiac Surgery

Oct. 03, 2020

Mitral regurgitation is a common finding in the transplanted heart. Re-do surgical valve repair or replacement incurs higher risk in these patients due to immunocompromised state, prior sternotomy and frequently other comorbidities. Cardiac procedures in this patient population are challenging because of the distorted anatomy of the transplanted heart. Abdallah El Sabbagh, M.D., and Peter M. Pollak, M.D., interventional cardiologists at Mayo Clinic in Jacksonville, Florida, recently treated a heart transplant patient who had developed severely symptomatic, medically refractory mitral regurgitation.

The patient is a 72-year-old male with a history of nonischemic cardiomyopathy who underwent orthotopic cardiac transplantation 18 months previously. He reported that after his transplantation, he was feeling much better, but a few weeks later he noticed dyspnea on exertion and drop in functional capacity during cardiac rehabilitation.

Echocardiography revealed severe mitral regurgitation secondary to leaflet malcoaptation. His medical therapy was optimized, but he continued to have severe symptoms. There was no evidence of active rejection. Coronary angiography was unremarkable. He was referred to Mayo Clinic in Jacksonville, Florida, for consideration of percutaneous intervention of his mitral valve.

Mitral regurgitation before and after MitraClip placement Enlarge image

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Mitral regurgitation before and after MitraClip placement

Mitral regurgitation before and after MitraClip placement

2D and color-flow Doppler images of mitral regurgitation before (A) and after (B) MitraClip (arrows) placement.

There are scattered case reports of MitraClip being used to treat mitral regurgitation in transplanted hearts, although this population has not been specifically studied in a randomized clinical trial. This patient underwent uncomplicated MitraClip placement, with almost complete resolution of symptoms within weeks of implantation.