Case Report: Emergent MitraClip Rescue for RCA STEMI Complicated by Papillary Muscle Rupture and Cardiogenic Shock
Abstract/Description
In this report, we describe the case of a 70 year-old-man who developed cardiogenic shock (CS) secondary to right ventricular failure and severe mitral regurgitation (MR). Initially, he presented to a community emergency department with a 3-day history of chest pain, dyspnea and blurry vision. An electrocardiogram showed inferior ST-segment elevations. A subsequent coronary angiography revealed a thrombotic occlusion of the right coronary artery (RCA). Despite successful percutaneous coronary intervention (PCI) and stenting, the patient experienced refractory hypoxemia and hemodynamic instability. The patient was transferred to a tertiary care center, where a transesophageal echocardiogram (TEE) showed a flail P2/P3 mitral valve leaflet from papillary muscle rupture. A right ventricular assist device was placed before the patient underwent emergent mitral transcatheter edge-to-edge (M-TEER) repair using two MitraClip XTW devices. The procedure lessened the severity of the MR from torrential (4+) to moderate (1+). This complex case illustrates the challenges of managing a coexisting triad of CS, MR, and ST-elevation myocardial infarction (STEMI). We will also highlight the utility of M-TEER in the setting of mechanical circulatory support.
Faculty Advisor/Mentor
Matthew Summers MD
Faculty Advisor/Mentor Email
mrsumme1@sentara.com
Faculty Advisor/Mentor Department
Sentara Cardiology
College/School/Affiliation
Sentara
Case Report: Emergent MitraClip Rescue for RCA STEMI Complicated by Papillary Muscle Rupture and Cardiogenic Shock
In this report, we describe the case of a 70 year-old-man who developed cardiogenic shock (CS) secondary to right ventricular failure and severe mitral regurgitation (MR). Initially, he presented to a community emergency department with a 3-day history of chest pain, dyspnea and blurry vision. An electrocardiogram showed inferior ST-segment elevations. A subsequent coronary angiography revealed a thrombotic occlusion of the right coronary artery (RCA). Despite successful percutaneous coronary intervention (PCI) and stenting, the patient experienced refractory hypoxemia and hemodynamic instability. The patient was transferred to a tertiary care center, where a transesophageal echocardiogram (TEE) showed a flail P2/P3 mitral valve leaflet from papillary muscle rupture. A right ventricular assist device was placed before the patient underwent emergent mitral transcatheter edge-to-edge (M-TEER) repair using two MitraClip XTW devices. The procedure lessened the severity of the MR from torrential (4+) to moderate (1+). This complex case illustrates the challenges of managing a coexisting triad of CS, MR, and ST-elevation myocardial infarction (STEMI). We will also highlight the utility of M-TEER in the setting of mechanical circulatory support.