MitraClip-procedure with two Mitra-Clips after indirect anuloplasty with the MONARC-device

Abstract: Mitral regurgitation is associated with a worsened prognosis in dilated cardiomyopathy. First standard therapy consists of a mitral valve reconstruction through heart surgery including heart lung machine. In patients with high co-morbidity, catheter-based techniques, have been developed. In the Evolution I study the MONARC-system which was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by over 1 grade was documented in 50% of patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip. It can be used for both functional and degenerativ mitral regurgitation. We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0-1 after implanting a MONARC-device four years ago with missing relevant reduction in mitral regurgitation. With this report we illustrated the management of Mitraclip in a patient with implanted MONARC-device and technical difficulties through the bowing of the posterior anulus.