Obstructive Hypertrophic Cardiomyopathy With Degenerative Mitral Regurgitation: A New Treatment Strategy Using Mavacamten Combined With M-TEER.

BACKGROUND

Transcatheter edge-to-edge mitral valve repair (M-TEER) has been demonstrated as an effective therapeutic option for patients with obstructive hypertrophic cardiomyopathy (oHCM) and concomitant degenerative mitral regurgitation. Mavacamten is a mechanism-based therapy for oHCM that can improve hemodynamics. However, clinical evidence on the concomitant use of mavacamten and M-TEER remains limited, and related case reports are scarce.

CASE SUMMARY: We present the case of a 79-year-old woman with symptomatic severe oHCM complicated by mitral valve prolapse, aortic stenosis, and secondary tricuspid regurgitation. Under the combined strategy of mavacamten and M-TEER, the patient experienced significant improvements in both symptoms and hemodynamics.

DISCUSSION: In oHCM, identifying the underlying mechanism of mitral regurgitation is crucial for therapeutic decision-making. Direct M-TEER in the setting of severe left ventricular outflow tract obstruction may carry specific risks and uncertainties. A stepwise strategy using mavacamten followed by M-TEER may reduce procedural risk while achieving more stable clinical and hemodynamic improvement.

TAKE-HOME MESSAGE: For oHCM patients with concomitant degenerative mitral regurgitation, the combined treatment of mavacamten and M-TEER represents a potential therapeutic option with complementary mechanisms.