title: Transcatheter Procedure for Residual Mitral Regurgitation After MitraClip Implantation Using Amplatzer Duct Occluder II.
abstract: This study reports a novel transcatheter procedure for residual mitral regurgitation (MR) after MitraClip implantation using the Amplatzer Duct Occluder II (ADO II).
  
  
  
  Although the MitraClip procedure is a transcatheter treatment option for patients at high surgical risk with severe MR, management of significant residual MR after MitraClip implantation is still challenging.
  
  
  
  We describe a case series of 9 consecutive patients who underwent transcatheter deployment of the ADO II plug for significant residual MR after MitraClip implantation from April to October 2015.
  
  
  
  The mean age was 79.3 ± 11.4 years. The deployment of the ADO II plug was performed at the initial MitraClip procedure in 7 patients and at the second procedure for recurrent symptoms in 2 patients. There were 2 types of residual MR seen after MitraClip implantation: residual commissural MR (n = 3) and residual intraclip MR (n = 6). The ADO II was successfully deployed with significant reduction of MR flow and left atrial pressure in all patients. The ADO II plug was retrieved in 1 patient because of device embolization to the ostial right coronary artery. However, all patients were discharged 1.8 ± 1.2 days after the procedure, with no significant MR on pre-discharge transthoracic echocardiography. In 8 patients who underwent 1-month symptomatic assessment, clinical symptoms were diminished to New York Heart Association functional class I or II.
  
  
  
  Transcatheter deployment of the ADO II plug was effective for the reduction of residual commissural MR and intraclip MR after MitraClip implantation. The potential role of this technique should be established for challenging cases.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Cox
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mizutani
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Uberoi
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Asma
authors.initials: A
authors.lastname: Hussaini
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Tat
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Moody
authors.initials: M
authors.lastname: Makar
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: karsk@cshs.org.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D015641:Radiography, Interventional; D019233:Retreatment; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Amplatzer Duct Occluder II; edge-to-edge mitral valve repair; mitral regurgitation