• Cardiovasc Revasc Med · Oct 2010

    Case Reports

    Percutaneous mitral valve annuloplasty for functional mitral regurgitation: acute results of the first patient treated with the Viacor permanent device and future perspectives.

    • Olivier F Bertrand, François Philippon, André St Pierre, Can M Nguyen, Eric Larose, Sylvie Bilodeau, François Dagenais, Eric Charbonneau, Josep Rodés-Cabau, and Mario Sénéchal.
    • Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada. olivier.bertrand@criucpq.ulaval.ca
    • Cardiovasc Revasc Med. 2010 Oct 1; 11 (4): 265.e1-8.

    BackgroundThere is a need to develop less invasive techniques to manage moderate or severe functional mitral regurgitation in patients at high surgical risk.ObjectiveWe report the acute results of the first patient treated with the permanent Viacor percutaneous transvenous mitral annuloplasty (PTMA) device in North America, introduce the PTOLEMY-2 protocol, and briefly discuss the current status of transvenous mitral valve techniques.Case ReportAfter several episodes of pulmonary edema, an 87-year-old woman was referred for hemodynamic evaluation. Angiography revealed normal coronary arteries and severe mitral regurgitation. Baseline echocardiography showed severe (4+) functional mitral regurgitation. The coronary sinus was cannulated with a 9.5-Fr introducer from a left subclavian approach. After distal positioning of a coronary wire, the 7-Fr PTMA Viacor catheter was advanced to the anterior interventricular vein. Two 130 g/cm rods were then inserted resulting in an acute and dramatic reduction in mitral regurgitation as assessed by continuous transoesophageal echocardiography and which was associated with a sudden rise in arterial blood pressure. The next day, transthoracic echocardiogram showed a significant reduction in effective regurgitant orifice area (EROA) from 41 to 10 mm(2). The patient was discharged home the day following the procedure without complication. In accordance with the PTOLEMY-2 protocol, she will undergo 3-D transthoracic echocardiograms, quality of life assessments, and 6-min walk tests at regular intervals for the next 5 years.ConclusionPTMA is a promising technique for the treatment of severe mitral regurgitation in selected patients. Further ongoing research will determine the predictors of success and long-term safety and performance of this technique.Copyright © 2010 Elsevier Inc. All rights reserved.

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