CaseStudy

An 80-year-old male patient presented to HVS Superspeciality Hospital with acute severe mitral regurgitation (MR) and complex coronary artery disease (CAD). The case was high-risk, involving multiple critical cardiac pathologies:

 

• Mitral Valve Disease: Acute, severe MR
• Coronary Artery Disease:
• Left Anterior Descending (LAD): Total occlusion, deemed non-viable
• Large Obtuse Marginal (OM) and Left Circumflex (LCX) arteries: Significant disease

 

The clinical challenge lay in managing both the valvular and ischemic burden, especially considering the patient's advanced age and comorbid status.

 

Treatment Plan:

1. Percutaneous Coronary Intervention (PCI) to LCX and OM — aimed at relieving the ischemic burden.

2. Staged Mitral Valve Repair using MitraClip therapy (Indian brand: Meril’s MyClip) — a revolutionary transcatheter edge-to-edge repair (TEER) system designed to reduce MR without the need for open-heart surgery.

 

Procedure 1: Angioplasty of LCX and OM

The first stage involved successful angioplasty and stenting of the LCX and OM arteries. The LAD was found to be non-viable, and hence not revascularized. The intervention restored perfusion to large myocardial territories and stabilized the patient for the second stage.

Outcome: Procedure was uneventful, and the patient showed significant symptomatic relief from angina and dyspnea.

 

Procedure 2: Mitral Valve Repair with MyClip

After cardiac stabilization, a transcatheter mitral valve repair was performed using the MyClip system by Meril Life Sciences — a cutting-edge Indian technology allowing precise, edge-to-edge leaflet approximation.

• A long and wide clip was chosen to effectively cover the regurgitant jet.
• Transesophageal echocardiography (TEE) guidance was used throughout the procedure.

 

Result: Post-clip deployment, there was only trivial residual MR, and the patient showed dramatic clinical improvement.

 

Team of Experts

This complex, staged hybrid intervention was made possible by the synergy of an expert multi-disciplinary team:

Interventional Cardiologists

• Dr. Meghav Shah
• Dr. Ankur Phatarpekar
• Dr. Amit Gangawani
• Dr. Harshad Sagar
• Dr. Kunal Patankar

 

Interventional Imaging Specialists

• Dr. Gourish Shinde
• Dr. Pravin Lovhale

 

Conclusion

This case highlights the power of team-based, staged, and minimally invasive therapy for managing complex cardiac disease in elderly patients. By combining revascularization with transcatheter mitral repair, the heart team at Heart & Vascular Superspeciality Hospitals was able to provide a new lease of life to a high-risk, elderly patient — without open-heart surgery.