New PASCAL Ace implant system in complex percutaneous mitral valve repair

Abstract

To the Editor, We present the case of a 73-year-old woman with arterial hypertension, morbid obesity (122 kg, body mass index = 44), and chronic lower limb swelling with recurrent skin infections due to multi-drug resistant microorganisms. She had a significant degenerative mitral regurgitation with moderate pulmonary hypertension and dyspnea, and NYHA functional class II. Despite the patients’ low surgical risk scores (1.5% and 1.29% in the Society of Thoracic Surgeons and EuroSCORE II scales, respectively) she was considered noneligible for mitral surgery because of her obesity and perioperative infectious risk. The heart team studied the case and decided to treat the mitral regurgitation with percutaneous treatment whose overall risk is lower. The patient’s informed consent was obtained for data publication in observance of the Declaration of Helsinki ethical principles. While planning the procedure, the presence of degenerative mitral regurgitation was confirmed associated with chord rupture and posterior leaflet eversion (flail) of the P1 scallop (figure 1A,B, asterisks) of 9 mm in height and 14 mm of amplitude. Quantitative parameters suggested a 1.3 cm2 anatomical regurgitant orifice, a 50 mL regurgitant volume, and a 51% regurgitant fraction with hemodynamic repercussion on the right superior pulmonary vein and systolic component reversal. The mitral...