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How to Mitral Breakout: Mitral Imaging I – Echo BasicsThursday, June 04, 2015
8:30 AM - 10:00 AM Room: Williford C, Third Floor
James Hermiller, MD, FACC, FSCAI
St Vincent Medical Group
St Vincent Hospital, Indianapolis IN
Secondary Mitral Regurgitation: How Should We Treat?
(Case Presentation)
How to Mitral Breakout: Mitral Imaging I – Echo BasicsThursday, June 04, 2015
8:30 AM - 10:00 AM Room: Williford C, Third Floor
James Hermiller, MD, FACC, FSCAI
St Vincent Medical Group
St Vincent Hospital, Indianapolis IN
Secondary Mitral Regurgitation: How Should We Treat?
(Case Presentation)
Disclosure Statement of Financial Interest
• Consulting Fees/Honoraria• Speaker Bureau
• Medtronic, Edwards, Abbott, BSC, and St Jude
• AstraZeneca
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
James Hermiller,MDAffiliation/Financial Relationship Company
History
• 84 year old man s/p prior MI, CABG, ICD, small CVA, presented in 2010 with 4+ functional MR
• Enrolled in REALISM study over 3 years ago
• Two Mitraclips placed with MR post procedure being trivial and follow up MR 1+
History• Over 6 months he developed progressive CHF
• Optimal medical therapy – QRS duration
110ms
• Echo/TEE 4+ severe MR
• Clips well positioned with MR lateral to the two mitraclips
• EF 20%/low output/Creatinine – 2.2 mg/dl
• Lives independently, married, and had been active until the last several months
ERO PISA - 0.62cm2RF – 53%RV 65cc
Plan
• Prohibitive risk for surgery/VAD
• Medical therapy – hospice vs 3rd clip
• Planned 3rd clip
• Strategy– Transseptal mid fossa and not too posterior
– Large valve area – low risk of stenosis
Follow Up
• 1+ MR – Device time 40 min
• Home the following day
• Renal function – post procedure
Cr fell to 1.6 mg/dl
• 6 months – FC II – No readmissions
6 moth F/U
Thanks for your attention!
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