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Transcatheter Mitral Valve Repair For Severe Mitral Regurgitation Using The HARPOON Device: Six-Month Outcome Case Report
Alison Duncan, Anan Daqa, Mindagas Norkunas, Neil Moat.
The Royal Brompton Hospital, London, United Kingdom.

Patient Demographics: A 62 year old lady presented with a 12 month history of increasing breathlessness and fatigue.
Relevant History: She had known mitral valve (MV) prolapse with severe mitral regurgitation (MR), but refused conventional MV surgery to avoid median sternotomy. Transthoracic echocardiography demonstrated P2 prolapse with severe MR, left ventricular (LV) end-diastolic dimension (EDD) 6.1cm and end-systolic dimension (ESD) 4.5cm, restrictive LV filling physiology, right ventricular (RV) impairment (TAPSE 15mm) and systolic pulmonary arterial pressure (PSAP) 40mmHg (Figure 1).
Pre-Operative Plan: Pre-procedural three-dimensional transoesophageal echocardiography (3DTOE) demonstrated a broad P2 prolapse with chordal rupture at the P2/P3 border and severe anterior MR. Pre-procedural multi-slice computerised tomography confirmed mitral annular dimensions of 47mm*42mm, and no flow limiting coronary artery disease. The patient was anatomically suitable for a Harpoon device and gave written informed consent.
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): The Harpoon procedure was performed on a beating heart through a small left thoracotomy using continuous TOE imaging. The device was inserted via the LV apex and guided to the LV surface of P2. Four preformed expanded polytetrafluoroethylene cords were anchored in P2, adjusted to the correct length to restore MV leaflet coaptation, and secured at the epicardium. There was no detectable MR at the end of the procedure (Figure 2). After 6-months, the patient's NYHA Class had fallen (III to I), and BNP reduced (174ng/L to 137ng/L). There was LV reverse remodelling (EDD 4.5cm, ESD 2.7cm), reduction in left atrial filling pressure and PSAP, and improvement in RV function (TAPSE 28mm). Continuous 3DTOE image-guided MV repair using the Harpoon device on a beating-heart may be a less-invasive alternative to conventional MV surgery, facilitating obliteration of severe MR with symptomatic improvement and LV reverse remodelling at 6-months.


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