LAUSR

A 70-year-old female patient with non-ischaemic dilated cardiomyopathy underwent MitraClip (MC) implantation for functional mitral regurgitation (MR) due to a combination of leaflet restriction and annulus dilatation. She continued to have progressive enlargement of the annulus over 30 months following MC implantation resulting in leaflet malcoaptation generating two regurgitant orifices (RO), causing recurrent severe functional MR (Panels A and B). The cumulative mitral valve orifice area was measured at 3 cm and was considered sufficient (Panel C) to complete the valve repair sequence by adding complementary percutaneous mitral annuloplasty using the CardioBand (CB) device. The annular reduction band was deployed in the standard manner without interfering with the previously implanted MC [Panel D shows implantation of the CB starting adjacent to the anterior lateral commissure, the guide catheter (GC) and classic drop out (DO) phenomenon caused by the transseptal sheath]. Once the CB was fully deployed cinching was performed, which reduced MR to mild (Panel E). Caution was exercised to confirm that sufficient diastolic valve opening preserved (Panel F) resulting in a mean diastolic pressure gradient of 4 mmHg. Percutaneous mitral annuloplasty is capable of successfully effecting mitral annular reduction, complementing mitral leaflet correction using the MC device. This is an effective strategy to treat functional MR of mixed aetiology. CardioBand shows great efficacy when annular dilatation predominately contributes to MR, whereas MC appears to be most efficient in pure leaflet restriction.