De Pryck Ophelia, Derthoo David, Cornelis Kristoff, Hens Lineke, Hiltrop Nick
Internal Medicine, Ghent University Hospital, Ghent, Belgium.
Cardiology, AZ Groeninge, Kortrijk, Belgium.
Acta Cardiol. 2025 Aug;80(6):541-544. doi: 10.1080/00015385.2024.2448868. Epub 2025 Jan 6.
Edge-to-edge mitral valve repair with MitraClip leads to a differed flow pattern and a decreased flow velocity at the left ventricle apex. This combination may lead to initiation of thrombus formation, especially in patients with severely reduced ejection fraction. The prevalence and mechanism of left ventricular thrombus formation after MitraClip implantation is still unknown.
We describe a case of a 74 year old women with a non-ischaemic cardiomyopathy and chronic heart failure with a severely reduced ejection fraction who was treated with a MitraClip for a severe secondary mitral valve insufficiency. One and a half year later she suffered from an ischaemic stroke due to a large thrombus at the ventricular side of the posterior mitral leaflet. Oral anticoagulation was started with complete resolution of the thrombus. We performed a literature review.
There are just a few case reports of this complication and two single centre observational retrospective studies on the prevalence of thrombus formation after MitraClip. They reported a divergent prevalence of 4.4% and 21%. Multiple hypotheses have been described such as the correction of the regurgitating blood that might be leading to more stasis of blood in the left ventricle. Another hypothesis states that the 2 divergent jets after the MitraClip can lead to an increase of shear stress, which might initiate thrombus formation.
Thrombus formation in the left ventricle after MitraClip implantation in patients with severely reduced ejection fraction is a rare complication. This case reports shows that it may occur even more than one year after the intervention. Permanent vigilance is warranted, especially in patients who are not chronically treated with oral anticoagulation.
使用MitraClip进行二尖瓣缘对缘修复会导致血流模式不同，左心室心尖处血流速度降低。这种情况可能会引发血栓形成，尤其是在射血分数严重降低的患者中。MitraClip植入术后左心室血栓形成的发生率及机制尚不清楚。
我们描述了一例74岁患有非缺血性心肌病和慢性心力衰竭且射血分数严重降低的女性患者，因严重继发性二尖瓣反流接受了MitraClip治疗。一年半后，她因二尖瓣后叶心室侧出现大血栓而发生缺血性中风。开始口服抗凝治疗后血栓完全溶解。我们进行了文献综述。
关于这种并发症仅有少数病例报告，以及两项关于MitraClip术后血栓形成发生率的单中心观察性回顾性研究。它们报告的发生率分别为4.4%和21%，存在差异。已经描述了多种假设，比如反流血液的纠正可能导致左心室血液更多地淤滞。另一种假设是，MitraClip术后的两股不同射流会导致剪切应力增加，这可能引发血栓形成。
射血分数严重降低的患者在MitraClip植入术后左心室血栓形成是一种罕见的并发症。本病例报告显示，这种情况甚至可能在干预一年多后发生。需要持续保持警惕，尤其是对于未长期接受口服抗凝治疗的患者。
