Butterfly in the Heart: Infective Endocarditis after MitraClip Procedure.

Published on Feb 15, 2018in CASE
· DOI :10.1016/J.CASE.2017.10.006
Aslannif Roslan2
Estimated H-index: 2
(NIH: National Institutes of Health),
Suraya Hani Kamsani1
Estimated H-index: 1
(NIH: National Institutes of Health)
+ 3 AuthorsWan Nabeelah Megat Samsudin2
Estimated H-index: 2
(NIH: National Institutes of Health)
The MitraClip procedure (Abbott Vascular, Santa Clara, CA) was introduced in 2003. As of July 2017, >50,000 patients have been treated worldwide.1 Six cases of infective endocarditis (IE) after repair with the MitraClip have been reported.2 Three of the six were caused by Staphylococcus aureus, and two of these patients died. Most of the patients were treated surgically.2, 3 Echocardiography plays a vital role in the diagnosis of IE. Transesophageal echocardiography (TEE) has higher sensitivity and specificity in diagnosing IE compared with transthoracic echocardiography (TTE).4, 5 We describe a patient who developed IE after MitraClip implantation, showing the importance of the role of echocardiography, especially TEE, after negative results on TTE.
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [††][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, MS, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD,
2,434 CitationsSource
#1Niklas BoederH-Index: 9
#2Oliver DörrH-Index: 18
Last. Holger NefH-Index: 51
view all 8 authors...
Abstract Background The MitraClip procedure can be an alternative treatment option for patients with high surgical risk for whom surgical treatment is contraindicated. Patients with prosthetic material have an increased risk for infective endocarditis. Hypothesis Incidence, treatment and outcome of patients with endocarditis after interventional mitral valve repair are not known. Methods We searched for articles using PubMed using the terms "interventional mitral valve repair", "mitraclip" and "...
8 CitationsSource
#1Florian DeuschlH-Index: 16
#2Niklas SchoferH-Index: 13
Last. Ulrich SchäferH-Index: 33
view all 5 authors...
The MitraClip (MC) system is a device for percutaneous, transseptal edge-to-edge reconstruction of the mitral valve (MV) in patients with severe mitral regurgitation (MR) not eligible for surgery. Recently, a number of studies have underlined the therapeutic benefit of the MC system for patients with extreme and high risk for MV surgery suffering from either degenerative or functional MR. The MC procedure shows negligible intraprocedural mortality, low periprocedural complication rates, and a si...
17 CitationsSource
#1Muhamed Saric (NYU: New York University)H-Index: 22
#2Alicia Armour (Duke University)H-Index: 3
Last. Kirsten Tolstrup (UNM: University of New Mexico)H-Index: 17
view all 10 authors...
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac s...
167 CitationsSource
#1Christian FrerkerH-Index: 29
#2Karl-Heinz KuckH-Index: 104
Last. Stephan GeidelH-Index: 14
view all 7 authors...
To report the first described case of a mitral valve infective endocarditis (IE) post MitraClip®.An 88-year-old patient at high surgical risk (log. EuroSCORE 30.4%) underwent a MitraClip procedure for severe eccentric organic mitral regurgitation (MR) due to prolapse with a flail leaflet of the P2 segment (flail gap 6 mm). After one month, the patient was readmitted to our department for fever and recurrence of shortness of breath. An echocardiogram demonstrated severe MR recurrence due to ulcer...
12 CitationsSource
Background The choice of the imaging modality (transthoracic [TTE] vs. transesophageal echocardiography [TEE]) for the diagnosis of infective endocarditis (IE) depends on different variables. Aim of the present study is to provide updated data on the diagnostic sensitivity and the clinical usefulness of TTE vs. TEE from the Italian Registry on IE (RIEI). Methods The RIEI has enrolled consecutive cases of IE in every participating centre, evaluating diagnostic and therapeutic data from a real wor...
7 CitationsSource
#1Laura Mauri (Brigham and Women's Hospital)H-Index: 95
#2Elyse Foster (UCSF: University of California, San Francisco)H-Index: 88
Last. Everest InvestigatorsH-Index: 7
view all 16 authors...
Objectives This study sought to evaluate 4-year outcomes of percutaneous repair versus surgery for mitral regurgitation. Background Transcatheter therapies are being developed to treat valvular heart disease. In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II trial, treatment of mitral valve regurgitation (MR) with a novel percutaneous device was compared with surgery and showed superior safety, but less reduction in MR at 1 year overall. We report the 4-year outcomes from the EVER...
334 CitationsSource
#3Alec Vahanian (University of Paris)H-Index: 112
#4Ottavio Alfieri (UniSR: Vita-Salute San Raffaele University)H-Index: 93
Last. Thomas WaltherH-Index: 66
view all 24 authors...
ACE : angiotensin-converting enzyme AF : atrial fibrillation aPTT : activated partial thromboplastin time AR : aortic regurgitation ARB : angiotensin receptor blockers AS : aortic stenosis AVR : aortic valve replacement BNP : B-type natriuretic peptide BSA : body surface area CABG : coronary artery bypass grafting CAD : coronary artery disease CMR : cardiac magnetic resonance CPG : Committee for Practice Guidelines CRT : cardiac resynchronization therapy CT : computed tomography EACTS : European...
2,949 CitationsSource
#1Ted Feldman (U of C: University of Chicago)H-Index: 91
#2Elyse Foster (UCSF: University of California, San Francisco)H-Index: 88
Last. Laura Mauri (Harvard University)H-Index: 95
view all 17 authors...
Background Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. Methods We randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite en...
1,175 CitationsSource
#1Gilbert HabibH-Index: 90
#2Luigi P. BadanoH-Index: 69
Last. Svend AakhusH-Index: 43
view all 11 authors...
Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short- and long-term prognosis, the prediction of embolic events, and the follow-up of patients under specific antibiotic therapy. Echocardiography is also useful for the diagnosis and management of the complications of IE, helping the physician in decision-making, particularly when a surgical therapy ...
308 CitationsSource
Cited By4
During the last decade there has been a craze for the percutaneous edge-to-edge mitral valve repair technique with the Mitra-Clip device. This is an alternative treatment to mitral valve surgery for severe mitral regurgitation. In France, this device is aimed at poor candidates for mitral valve surgery. It involves intra-cardiac prosthetic material, which exposes them to the risk of bacterial endocarditis. The consequences of this infective disease can be dramatic, especially for these old patie...
Last. Martin Brown (Macquarie University)H-Index: 8
view all 3 authors...
Background The incidence of infective endocarditis (IE) following a MitraClip is rare with 17 reported cases in the literature. The reported mortality rate is high, at 41%, despite both medical and surgical therapies. To date, this is the first documented case of IE following a MitraClip procedure in Australia. Case summary An 88-year-old male presented with a 1-week history of confusion and dyspnoea. Clinical examination was significant for a temperature of 37.7°C, a pansystolic murmur and bila...
#1Mikhael F. El-Chami (Emory University)H-Index: 23
#2Matthew D. BonnerH-Index: 7
Last. Laurence M. EpsteinH-Index: 59
view all 8 authors...
Abstract Pacemaker related infections remain a constant concern due to increased risk for patient morbidity and mortality. While transvenous pacemakers are expected to have an infection rate ranging from 0.77% to 2.08%, there have been no cases of leadless pacemaker infection reported in clinical trials enrolling more than 3000 patients. There are many potential reasons that leadless pacemakers may be resistant to infection including the absence of a subcutaneous pocket and leads, reduced skin a...
14 CitationsSource
#1Elizabeth Rempfer (WVU: West Virginia University)H-Index: 1
#2Hayden D. Basinger (WVU: West Virginia University)H-Index: 1
Last. Joseph Minardi (WVU: West Virginia University)H-Index: 6
view all 6 authors...
Abstract Background Management of mitral valve regurgitation in patients with multiple comorbidities is complicated because of poor surgical candidacy. Less invasive techniques for these patients include the MitraClip device, an endovascular repair option used to reduce mitral valve regurgitation symptoms. However, complications include leaflet damage, stenosis, and infectious endocarditis. Case Report Four years after MitraClip placement, an 80-year-old man presented to the emergency department...
1 CitationsSource