Successful transcatheter edge-to-edge repair with MitraClip in patient with left sided inferior vena cava

Excerpt

A 75-year-old man was referred to our center for decompensated heart failure. Transthoracic echocardiography revealed severe mitral regurgitation with posterior flail (P2). He was at a high risk for open-heart surgery; therefore, our heart team decided to perform transcatheter edge-to-edge repair (TEER) with the MitraClip (Abbott Vascular, Menlo Park, California). A computed tomography (CT) revealed left sided inferior vena cava (IVC) (Fig. 1A). The left femoral vein approach was one of the options, however right femoral vein approach seems reasonable for better controlling the clip delivery system. After the transseptal puncture, there was difficulty advancing the steerable guide catheter (SGC) to the left atrium using the Amplatz Super Stiff wire (Boston Scientific, Marlborough, MA) even with fairly strong force. Therefore, the Lunderquist wire (Cook Medical, Bloomington, IN) was replaced by the super stiff wire using 5Fr multipurpose catheter to keep left upper pulmonary vein, and the SGC finally reached a left atrium (Fig. 1B). With additional + Knob for making the tip of the SGC directed to mitral valve perpendicularly, TEER was successfully done with a single MitraClip G4 XTW device (Fig. 1 C, D and E). No complications were noticed and the patient was discharged with trace mitral regurgitation.

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