Anaesthesia for transcatheter mitral valve repair

Question 1

Causes of mitral regurgitation

Answer 1

Primary (organic)
- Rheumatic fever
- Infective endocarditis
- Connective tissue disease (Marfan’s, Ehlers-Danlos)

Secondary (functional)
- Hypertrophic or dilated cardiomyopathy
- MI leading to papillary muscle ischaemia or rupture
- Left ventricular aneurysm

Question 2

Methods of transcatheter mitral valve repair

Answer 2

• Edge-to-edge repair
• Annuloplasty

Question 3

Conditions associated with severe mitral regurgitation

Answer 3

• Pulmonary hypertension
• Tricuspid regurgitation
• HF with reduced EF
• AF

Question 4

Haemodynamic goals with managing patient with mitral regurgiation

Answer 4

• GA is generally good as it reduces afterload
• Hypotension can be treated with ephedrine or phenylephrine (careful as increase in afterload bad)
• Avoid bradycardias
• Maintain pre-load and contractility

Question 5

Anaesthetic nuances for transcatheter mitral valve repair

Answer 5

• Art line and TOE
• Long procedure, low light levels, difficult to access patient, remote anaesthesia in cath lab
• Rarely need CVC
• May need furosemide to reduce LV size during clipping of valve
• Can give peripheral dopamine
• PEEP 5-10 ok, higher will significantly reduce pre-load
• Will need heparin (often aiming ACT 250-300secs)

Question 6

Complications following transcatheter mitral valve repair

Answer 6

• Bleeding from femoral vein
• Retroperitoneal haematoma
• Pericardial tamponade
• Oesophageal injury from TOE
• AKI
• Mitral stenosis and pulmonary oedema