title: Progressive Mitral Stenosis After MitraClip Implantation in a Patient With Systemic Inflammatory Disease.
abstract: We describe a patient at high surgical risk who was successfully treated with a MitraClip (Abbott Vascular, Menlo Park, CA) without transmitral gradient. She received corticosteroid therapy for systemic lupus erythematosus, and progressive mitral stenosis developed late after MitraClip implantation. It gradually increased and reached 23 mm Hg at 28 months after the procedure; during the same period, her dose of prednisone had to be increased owing to lupus flare. Systemic inflammatory disease has the potential to result in mitral valve inflammation and fibrosis, ultimately causing thickening of the tissue bridge and worsening of the mitral valve obstruction. Preprocedural counseling regarding durability may help in this population.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Mike
authors.initials: M
authors.lastname: Saji
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Dale E
authors.initials: DE
authors.lastname: Fowler
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia.
authors.forename: John M
authors.initials: JM
authors.lastname: Dent
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia. Electronic address: sl9pc@virginia.edu.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones