European heart journal. Case reports · 2024
Transcatheter mitral valve repair for a patient with double inferior vena cava: case report.
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Kato Riku, Hosoba Soh, Kuroda Masayuki, Yasuda Kenichiro
Аннотация
BACKGROUND: A transcatheter edge-to-edge repair (TEER) is disseminating gradually as a treatment for primary and secondary mitral regurgitation (MR) in patients with high surgical risk. In performing TEER, securing a safe access route is crucial. We report a case with a challenging access route due to the presence of a double inferior vena cava (IVC) and the patient's small body habitus.
CASE SUMMARY: An 84-year-old female presented with congestive heart failure due to severe MR. Despite receiving optimal medical therapy, her symptoms did not improve significantly. Transcatheter edge-to-edge repair was deemed challenging due to her extremely small body habitus [height: 131 cm; body surface area: 1.17 m2] and the presence of double IVC. However, considering her inoperable risk for surgical repair, she underwent TEER after a multidisciplinary heart team discussion. The steering guide catheter (SGC) encountered resistance, but gradual advancement and use of a bougie with a large bore sheath dilator successfully delivered the SGC to the right atrium. Following the TEER, there was a significant improvement in the symptoms.
DISCUSSION: Extremely small venous system in a small patient with double IVC presented a unique technical hurdle. Transcatheter edge-to-edge repair is potentially feasible even in such a patient by cautiously applying the technique described.
CASE SUMMARY: An 84-year-old female presented with congestive heart failure due to severe MR. Despite receiving optimal medical therapy, her symptoms did not improve significantly. Transcatheter edge-to-edge repair was deemed challenging due to her extremely small body habitus [height: 131 cm; body surface area: 1.17 m2] and the presence of double IVC. However, considering her inoperable risk for surgical repair, she underwent TEER after a multidisciplinary heart team discussion. The steering guide catheter (SGC) encountered resistance, but gradual advancement and use of a bougie with a large bore sheath dilator successfully delivered the SGC to the right atrium. Following the TEER, there was a significant improvement in the symptoms.
DISCUSSION: Extremely small venous system in a small patient with double IVC presented a unique technical hurdle. Transcatheter edge-to-edge repair is potentially feasible even in such a patient by cautiously applying the technique described.