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!