title: Not for adults only: MitraClip use in a paediatric patient.
abstract: We present the primary report of a paediatric patient who had placement of the MitraClip device for severe functional mitral regurgitation. The patient was a 14-year-old boy with symptomatic end-stage non-compaction type cardiomyopathy secondary to a mitochondrial cytopathy. He had severe mitral regurgitation, tricuspid valve regurgitation, a severely dilated LV with apical non-compaction, severe LV dysfunction and severe pulmonary hypertension. Despite optimal medical therapy he developed progressive symptoms of congestive heart failure and he was not a candidate for an assist device or cardiac transplantation. Multimodality imaging with fluoroscopy, two-dimensional and three-dimensional transoesophageal echocardiography was used to guide the procedure. Two MitraClips were placed resulting in an adequate decrease in MR severity to no more than mild-moderate. Five months post MitraClip implantation, he has improved exercise tolerance. Transthoracic echocardiography showed mild to moderate mitral regurgitation and a decrease in left ventricular size. To our knowledge, this is the first reported paediatric patient to be offered this innovative procedure. Percutaneous edge-to-edge MV repair may prove to be a novel and effective palliation to consider in a subgroup of paediatric, adolescent and young adult patients. This case report describes some of the considerations specific to the paediatric patient.
authors.affiliation: Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Joffe
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Jones
authors.forename: Mark
authors.initials: M
authors.lastname: Reisman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Perpetua
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuler
authors.forename: G Burkhard
authors.initials: GB
authors.lastname: Mackensen
mesh_terms: D000293:Adolescent; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000209:etiology; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008297:Male; D028361:Mitochondrial Diseases / Q000150:complications; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D065886:Neurodevelopmental Disorders / Q000209:etiology; D013525:Surgical Instruments; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology