VCOM Louisiana Research Day Program Book 2024

Case Studies

Dr. Nauman Khalid, MD; Dr. Niku Thapa, MD; Saahir Mukherjee, OMS-III Saint Francis Medical Center; VCOM 53 INCIDENCE OF PRIMARY MITRAL REGURGITATION IN ADULT WITH REPAIRED CONGENITAL TETRAOLOGY OF FALLOT AND OUTCOME OF TRANSCATHETER EDGE TO EDGE REPAIR WITH MITRACLIP™ IN THIS POPULATION: A CASE REPORT

Background: Mitral Transcatheter Edge-to Edge Repair (TEER) is indicated in individuals with moderate to severe symptomatic primary or secondary mitral regurgitation who are not surgical candidates. Clinical outcomes of TEER for significant mitral regurgitation in a patient with a history of previous congenital heart defects and subsequent correctional surgeries warrants further assessment. Results: Case Description: A 68-year-old man with a history of atrial fibrillation, asthma, biventricular implantable cardioverter defibrillator, Tetralogy of Fallot (TOF) status post repair, right aortic arch, ventricular tachycardia and premature ventricular contractions, and peripheral vascular disease (PVD) status post angioplasty, and hypertension presented to the cardiology clinic for increasing fatigue and shortness of breath. Device interrogation showed significant ventricular tachycardia. The patient was intolerant to Amiodarone and was started on Sotalol 40 mg twice daily, but has also reported increasing chest pain since then. Other than initial complaints, review of systems and physical exam was unremarkable. The patient was switched to Mexiletine 150 mg three times daily. A previous echocardiogram two months ago showed an EF of 65% with moderate to severe eccentric

primary/degenerative mitral valve regurgitation. Transesophageal echocardiogram showed tethering of the posterior mitral valve leaflet, moderate to severe mitral regurgitation and blunting of systolic pulmonary venous flow, and preserved left ventricular systolic function. Coronary angiogram showed normal coronary arteries and right heart catheterization showed normal cardiac output/index and mildly elevated heart filling pressures for which he was started on Sacubitril/Valsartan 24-26 mg twice daily. The patient was subsequently referred to cardiovascular surgery for surgical evaluation but because of extensive surgical history, comorbidities and frailty he was deemed high-risk for redo surgery and therefore TEER with MitraClip was successfully performed. Follow-up echocardiogram showed well-seated MitraClip™ without residual mitral regurgitation and no pericardial effusion. The patient reported significant improvement in his dyspnea and exercise tolerance. Conclusions: The incidence of primary mitral valve regurgitation in a patient with surgically repaired Tetralogy of Fallot is not well-defined and outcome of TEER in such cohort warrants additional evaluation.

75 2024 Via Research Recognition Day