Percutaneous MitraClip Implantation in an Adult with Functionally Univentricular Physiology

Background: Atrioventricular valve regurgitation in functionally single ventricle physiology in adults with congenital heart diseases is associated with an increased risk of morbidity and mortality.

Methods: We report the case of a 34-year-old female patient with complete AVSD, DORV and TAPVC of mixed type who was palliated s/p by a modified left and right BT shunt at the age of 5 and 16 years without further PCPC or TCPC completion and good quality of life. After thrombotic occlusion of the right BT shunt at the age of 32 years she underwent new BT shunt placement (left A. brachiocephalic to main pulmonary artery) at an outside hospital. The postoperative course was complicated by acute renal failure, cardiac arrhythmias and ECMO from which she finally was weaned. The patient discharged herself against medical advice 9 weeks after surgery. Due to rapid deterioration of her general condition with cardiac decompensation, she presented to our hospital on the evening of discharge. Echocardiography showed satisfactory cardiac function with significant regurgitation of the left AV valve. The patient`s condition deteriorated further leading to combined renal and respiratory failure, for which the patient was intubated and subsequently underwent tracheostomy placement and renal replacement therapy. Cardiac catheterization showed an increased pulmonary artery pressure of 27mmHg. Both left-sided BT shunts were open with SaO2 of 79%. Finally, transfemoral clipping of the left AV valve was performed 7 weeks after admission, thereby significantly reducing the regurgitation (to only mild) without relevant stenosis. Her clinical condition improved and she was discharged home 4 weeks after placement of the mitral clips. During follow-up 8 weeks post clip placement the patient has improved exercise capacity and quality of life.

Conclusion: Management of adults with single ventricle physiology remains challenging and requires multidisciplinary and specialized care. Percutaneous atrioventricular valve repair in adults with CHD is feasible and can be performed as an alternative for surgery in high-risk patients.

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Artikel online veröffentlicht:
13. Februar 2024