title: Severe infective endocarditis after MitraClip implantation treated by cardiac surgery.
abstract: OBJECTIVE
  To report the first described case of a mitral valve infective endocarditis (IE) post MitraClip®.
  
  
  RESULTS
  An 88-year-old patient at high surgical risk (log. EuroSCORE 30.4%) underwent a MitraClip procedure for severe eccentric organic mitral regurgitation (MR) due to prolapse with a flail leaflet of the P2 segment (flail gap 6 mm). After one month, the patient was readmitted to our department for fever and recurrence of shortness of breath. An echocardiogram demonstrated severe MR recurrence due to ulceration in the region of the posterior leaflet despite good insertion of both clips, and a large vegetation of 1513 mm within the clip region. Blood cultures were positive for staphylococcus aureus. The patient was treated by cardiac surgery with mitral valve replacement due to IE despite a very high logistic EuroSCORE of 56.8%. Histological and bacteriological analysis of the clip devices confirmed active IE. After cardiac surgery, transthoracic echocardiography showed no mitral regurgitation and a mean gradient across the mitral valve bioprosthesis of about 5 mmHg. The patient was discharged to a rehabilitation department 15 days after cardiac surgery.
  
  
  CONCLUSIONS
  Surgical treatment as bail-out therapy for MR recurrence secondary to IE after MitraClip can be successfully carried out despite a high surgical risk.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Tobias
authors.initials: T
authors.lastname: Schmidt
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Stephan
authors.initials: S
authors.lastname: Geidel
mesh_terms: D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004696:Endocarditis / Q000175:diagnosis / Q000382:microbiology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D012306:Risk; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013525:Surgical Instruments / Q000382:microbiology*; D016896:Treatment Outcome