A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.
Aged ; Cardiac Surgical Procedures ; methods ; Cardiology ; instrumentation ; methods ; Catheters ; Echocardiography ; methods ; Equipment and Supplies ; Female ; Heart Ventricles ; physiopathology ; Humans ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; surgery ; Pulmonary Disease, Chronic Obstructive ; complications ; Risk ; Ultrasonography, Doppler ; methods ; Ventricular Dysfunction, Left ; surgery

BACKGROUND/AIMS: Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD. METHODS: For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89). RESULTS: The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event. CONCLUSIONS: The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.
Aged ; Chi-Square Distribution ; *Echocardiography, Doppler ; Female ; Glomerular Filtration Rate ; Heart Failure, Diastolic/*mortality/physiopathology/*ultrasonography ; Humans ; Incidence ; Kaplan-Meier Estimate ; Kidney/physiopathology ; Linear Models ; Male ; Middle Aged ; Mitral Valve/physiopathology/ultrasonography ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Renal Insufficiency, Chronic/diagnosis/*mortality/physiopathology ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Stroke Volume ; Time Factors ; Ventricular Function, Left