Transcatheter mitral valve repair by TEER device for recurrent eclipsed mitral regurgitation: A case report

Abstract

Introduction

Eclipsed mitral regurgitation (MR) is a rare entity of mitral regurgitation, characterized by a transient, reversible, and massive functional MR caused by a sudden coaptation defect without a reduction of the left ventricule ejection fraction. Even though ischemic hypotheses and variations in blood volume are potential causes, the exact pathophysiology of this rare occurrence remains unclear.

Objective

Several cases of eclipsed MR were reported in the literature with distinct therapeutic strategies that were associated with a significantly high risk of mortality following surgery. Only few cases treated by a transcatheter edge-to-edge repair (TEER) procedure was previously reported.

Method

We report the case of an 83-year-old woman with Eclipsed MR, that was successfully treated by a TEER procedure in our institution.

Results

An 83-year-old woman, with a known history of high blood pressure, dyslipidemia, and paroxysmal atrial fibrillation, presented with acute paroxysmal chest pain and dyspnea. A trans-thoracic echocardiogram (TTE) done a few months ago only showed a mild mitral regurgitation with a preserved ejection fraction. The patient was then transferred to the intensive cardiac care unit due to the high-risk setting of continuous heart failure, persistent AF, and chest pain. Increased troponin levels, and the suspicion of modification of repolarization on the ECG urged us to perform a coronary angiography that found one tight stenosis on the proximal left anterior descending artery, managed by one stent insertion.

After an initial clinic recovery, the patient suffered three severe episodes of cardiac decompensation with the need for catecholamines. During one of these episodes, TTE demonstrated a severe MR with regression on mild regurgitation at the same time (Table 1). To prevent recurrence in addition to the medical treatment, implantation of a TEER device on the mitral valve was successfully carried out, without complications and clinical recurrence of heart failure after six months of follow-up.

Conclusion

Severity of the eclipsed MR-related crises in this patient highlights the utmost importance of a rapid and accurate diagnosis to offer the earliest adapted management approaches to this uncommon cause of MR. Implantation of a TEER device seems proved to be a plausible and successful technique to manage eclipsed MR patients with reduced complications.