Mitral valve transcatheter edge-to-edge repair as a bridge to treat aortic dissecting aneurysm in a case of Marfan syndrome: a case report

TL;DR

This case report describes a patient with Marfan syndrome who had aortic aneurysm and mitral valve regurgitation, treated with a staged approach using transcatheter repair as a bridge to surgery.

Contribution

The paper presents a novel application of MV-TEER as a bridge therapy in a rare case of Marfan syndrome with complex cardiovascular issues.

Findings

MV-TEER was successfully used to stabilize the patient's heart failure before surgery for aortic aneurysm.

Staged treatment with MV-TEER followed by surgery was effective in managing high-risk cardiovascular conditions in a Marfan syndrome patient.

MV-TEER is a potential bridge therapy for complex cases where immediate surgery is too risky.

Abstract

Marfan syndrome is an inherited disorder that manifests with various cardiovascular conditions. This case report discusses a patient with Marfan syndrome presenting with concurrent dissecting aortic aneurysm and acute mitral valve regurgitation (MR), exploring treatment strategies for this unique case.

A 57-year-old man diagnosed with Marfan syndrome presented with progressive dyspnoea and awareness of orthopnoea. Acute heart failure (HF) due to acute MR associated with chordae rupture was diagnosed. However, contrast-enhanced CT revealed the coexistence of a massive dissecting aortic aneurysm, indicating surgical intervention. The dissecting aortic aneurysm extended over a large area. Given the high risk of simultaneous surgery with the mitral valve, a staged approach was adopted. Mitral valve transcatheter edge-to-edge repair (MV-TEER) was performed as the initial step to reduce the perioperative HF risk, followed by a planned two-stage surgery for the dissecting aortic aneurysm. This strategy effectively facilitated surgical intervention for the dissecting aortic aneurysm in the chronic phase after MV-TEER.

Several reports showed the effectiveness of MV-TEER in cases of degenerative MR where surgical operation carries a high risk, but case report of MV-TEER in Marfan syndrome is rare. In recent years, the effectiveness of MV-TEER has also been reported as a ‘bridge therapy’ for heart transplantation. Mitral valve transcatheter edge-to-edge repair is considered a potential option to serve as a bridge to other invasive intervention.

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