A 66 year old male with a history of cardiomyopathy, myocardial infarction, and congestive heart failure underwent a MitraClip procedure to treat functional mitral regurgitation. The procedure was performed using echocardiography guidance to place clips on the mitral valve to reduce regurgitation. In the days following the procedure, the patient's condition improved and he was discharged from the hospital. At a 3 month follow up, the mitral regurgitation was still mildly reduced and the patient's heart function and symptoms had improved.

1. Francesco Maisano MD

2. Oct 23 rd 2008 Functional MR pt San Raffaele Hospital Equipe Maisano, Michev, La Canna, Alfieri, Colombo

3. 66 yo, male, 64 Kg, 164 cm, BSA 1.7 m2, BMI 24 Post-ischemic Cardiomyopathy, CCS II, NYHA III Comorbidities Infrarenal abdominal aneurysm 2006 stenting of right common carotid artery and right internal carotid artery 2005 Bone Marrow Tx for AML 1994 anterior AMI ; 2001 PCI followed by CABG (LIMA—LAD ), followed by multiple PTCA with DES 1/2008: AMI for intrastent thrombosis -> POBA on LAD 4/2008 Acute Pulmonary Edema  CRT with Biventricular Pacing and ICD Log ES: 45%; STS risk 20%

4. Dilated ischemic cardiomyopathy LVEDV: 211ml LVESV: 165 ml Severe LV dysfunction (EF 20%) Severe MR ( ERO 0,2 cm2) Severe tethering TA 4,1 cm2; CD 1,7 cm Annular dilatation SL 38 mm; IC 46 mm); Severe Pulmonary Hypertension (75mmHg), RV failure, Moderate tricuspid regurgitation

9. Central MR MR jet width below 1.5 cm Coaptation length >3 mm Coaptation depth 1.7

10. Right femoral vein access with a 6F introducer Left femoral artery with a 6 F introducer Pigtail in the ascending aorta Standard transeptal puncture setup

12. Line of coaptation

13. 3.5 cm 3.3 cm

14. Extra Stiff Amplatz exchange length wire (.035”) in upper PV or large loop in LA through the Mullins sheath

18. Coils Coils Guide Marker LA RA

19. Guide Marker Amplatz Guide

20. Requires a Controlled, Systematic & Iterative approach Imaging guidance Primarily Echocardiography (aided by Fluoroscopy) 3-D positioning using 4 key echo views LVOT and (Inter-) Commissural views SAX at base and TG-SAX views Position adjustments Multiple “controls” available Knobs; Torque; Translation

23. Soft tip of guide

24. Clip Guide Marker Sleeve Markers

36. Guide Steerable sleeve Clip delivery handle Stabilizer Atrial Septum

40. Guide Steerable sleeve Clip delivery handle Stabilizer Atrial Septum

68. A high risk surgical candidate has been submitted to Mitraclip procedure to treat FMR The patient was transferred from ICU to the general ward in day 1 and discharged home 4 days after the procedure At 3 months the MR reduction is stable with mild residual MR, reduction of LV volumes, and the patient is in NYHA class II