2022 年 4 巻 1 号 p. 51-55
Objective: Acute mitral regurgitation (MR) secondary to papillary muscle rupture (PMR) is a lethal complication of acute coronary syndrome. Although surgery is considered the first-line therapy for this condition, some of these patients have no choice but to quit with prohibitively high surgical risk. Transcatheter mitral valve edge-to-edge repair (TEER) using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is an established treatment option and viable alternative for patients with high-risk or prohibitive-risk open heart surgery.
Case Presentation: We present a case of successful TEER for a patient with severe MR due to PMR after acute myocardial infarction using the MitraClip. The patient, who had post-gastrectomy peritonitis, was in a critical condition. After a few days, he developed acute heart failure with cardiogenic shock. Emergency angiography revealed severe left main-trunk stenosis. A percutaneous coronary intervention was performed for the culprit lesion under a ventilator and an intra-aortic balloon pump support. Echocardiography revealed massive MR with a partial tear in the posteromedial papillary muscle and a large regurgitant jet directed to the posterior wall with severely reduced left ventricular function. We performed TEER using three clips, which resulted in mild residual MR. Subsequently, the patient was hemodynamically stabilized.
Conclusion: TEER with the MitraClip system is a viable treatment option for cardiogenic shock due to PMR.
