2021 年 85 巻 5 号 p. 693-
Single leaflet device attachment (SLDA) is a complication of MitraClip,1 but hemolytic anemia due to SLDA has not been reported. A symptomatic 90-year-old woman referred to our institution and severe mitral regurgitation (MR) due to large posterior mid-medial leaflet prolapse was present (Figure A). MitraClip therapy was selected considering her high operative risk.
(A–C,F) Three-dimensional transesophageal echocardiography (TEE) enface views at each event during MitraClip deployment. (D,E) Fluoroscopy revealed excess mobility of the first clip during systole (D) and diastole (E). (G,H) TEE showed the first clip (G; *yellow dashed circle) horizontally sucked into the left atrium by the mitral regurgitation (MR) jet during systole, despite the insertion of a second clip (G; **yellow dashed circle), resulting in collision between the MR jet and the first clip (H).
The first clip was deployed at the mid-medial position (Figure B) and MR became mild; however, soon after, severe MR reoccurred and the clip was detached from the anterior leaflet (Figure C). We tried to place the second clip at the middle position where the MR jet was located, but the first clip was horizontally blocked the way during systole (Figure D,E). The second clip was deployed at the medial position (Figure F), but severe MR remained. Two days later, elevated lactate dehydrogenase (966 U/L) and decreased hemoglobin (8.8 g/dL) were observed. Transesophageal echocardiography revealed a collision between the MR jet and the first clip during systole (Figure G,H; Supplementary Movie).
T.N. is a member of Circulation Journal’s Editorial Team. The authors have no financial conflicts of interest.
Supplementary Movie.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-20-1297
