Ischaemic stroke due to thrombus formation on the ventricular side of the mitral valve more than one year after MitraClip implantation: a case report.

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ophelia De Pryck, David Derthoo, Kristoff Cornelis, Lineke Hens, Nick Hiltrop
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引用次数: 0

Abstract

Objectives: Edge-to-edge mitral valve repair with MitraClip leads to a differed flow pattern and a decreased flow velocity at the left ventricle apex. This combination may lead to initiation of thrombus formation, especially in patients with severely reduced ejection fraction. The prevalence and mechanism of left ventricular thrombus formation after MitraClip implantation is still unknown.

Methods: We describe a case of a 74 year old women with a non-ischaemic cardiomyopathy and chronic heart failure with a severely reduced ejection fraction who was treated with a MitraClip for a severe secondary mitral valve insufficiency. One and a half year later she suffered from an ischaemic stroke due to a large thrombus at the ventricular side of the posterior mitral leaflet. Oral anticoagulation was started with complete resolution of the thrombus. We performed a literature review.

Results: There are just a few case reports of this complication and two single centre observational retrospective studies on the prevalence of thrombus formation after MitraClip. They reported a divergent prevalence of 4.4% and 21%. Multiple hypotheses have been described such as the correction of the regurgitating blood that might be leading to more stasis of blood in the left ventricle. Another hypothesis states that the 2 divergent jets after the MitraClip can lead to an increase of shear stress, which might initiate thrombus formation.

Conclusion: Thrombus formation in the left ventricle after MitraClip implantation in patients with severely reduced ejection fraction is a rare complication. This case reports shows that it may occur even more than one year after the intervention. Permanent vigilance is warranted, especially in patients who are not chronically treated with oral anticoagulation.

二尖瓣植入1年多后二尖瓣心室侧血栓形成缺血性卒中1例。
目的:使用MitraClip进行二尖瓣边缘到边缘修复可导致不同的血流模式和左心室尖顶血流速度降低。这种组合可能导致血栓形成,特别是在射血分数严重降低的患者中。MitraClip植入后左室血栓形成的发生率和机制尚不清楚。方法:我们描述了一个74岁的女性与非缺血性心肌病和慢性心力衰竭严重降低射血分数谁是用米特拉普治疗严重继发性二尖瓣功能不全。一年半后,由于二尖瓣后小叶的心室侧有一个大血栓,她患上了缺血性中风。在血栓完全溶解后开始口服抗凝。我们进行了文献综述。结果:仅有少数病例报告和两项单中心观察性回顾性研究MitraClip后血栓形成的发生率。他们报告的患病率分别为4.4%和21%。多种假设已经被描述,如纠正反流的血液,可能导致更多的血液淤积在左心室。另一种假说认为,MitraClip后的2个不同的射流可能导致剪切应力增加,从而可能引发血栓形成。结论:在射血分数严重降低的患者中,MitraClip植入后左心室血栓形成是一种罕见的并发症。本病例报告显示,这种情况甚至可能在干预后一年多发生。长期保持警惕是必要的,特别是那些没有长期接受口服抗凝治疗的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta cardiologica
Acta cardiologica 医学-心血管系统
CiteScore
2.50
自引率
12.50%
发文量
115
审稿时长
2 months
期刊介绍: Acta Cardiologica is an international journal. It publishes bi-monthly original, peer-reviewed articles on all aspects of cardiovascular disease including observational studies, clinical trials, experimental investigations with clear clinical relevance and tutorials.
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