First described mitral clip in an adult extracardiac Fontan patient: a case report

Christiane L Haeffele; George K Lui; Lynn Peng; Frandics Chan; Rahul P Sharma

doi:10.1093/ehjcr/ytac479

First described mitral clip in an adult extracardiac Fontan patient: a case report

Eur Heart J Case Rep. 2022 Dec 16;7(1):ytac479. doi: 10.1093/ehjcr/ytac479. eCollection 2023 Jan.

Authors

Christiane L Haeffele^{1

2}, George K Lui^{1

2}, Lynn Peng², Frandics Chan³, Rahul P Sharma¹

Affiliations

¹ Department of Medicine, Division of Cardiovascular Medicine, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA.
² Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA.
³ Division of Radiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA.

Abstract

Background: The use of transcatheter edge-to-edge repair (TEER) in patients with advanced heart failure has been shown to reduce hospitalizations and increase survival. As patients with Fontan circulations grow older, a significant proportion of them will develop severe atrioventricular (AV) valve regurgitation in the systemic ventricle. Conventional surgical repair and transplant carry high mortality risk for the adult Fontan patient with progressive heart failure.

Case summary: A 51-year-old female extracardiac Fontan patient developed severe AV valve regurgitation and progressive functional decline. Based on her operative risk for conventional surgical intervention or transplant, TEER using the Abbott MitraClip device was performed. The degree of mitral regurgitation was decreased from severe to moderate regurgitation.

Discussion: This is the first known case describing the use of a successful TEER in an adult patient with an extracardiac Fontan. Given the increasing numbers of patients surviving into adulthood with a Fontan circulation, transcatheter interventions may provide an alternative treatment option to conventional surgeries and medical therapies.

Keywords: Adult congenital heart disease; Case report; Fontan; Heart failure; Mitral clip; Transcatheter edge-to-edge repair.

Publication types

Case Reports