Dynamic Mitral Regurgitation Treated with MitraClip.

Dear Editor, dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised.In addition, evidence on therapeutic options for dynamic MR has been lacking.We report the case of a 48-yearold woman who underwent coronary revascularisation and extra-corporeal membrane oxygenation (ECMO) support after post-operative cardiac collapse from left main (LM) coronary artery occlusion.However, she had difficulty coming off the ventilator due to recurrent pulmonary oedema from dynamic MR.She was treated with percutaneous mitral valve repair using the MitraClip system (Abbott Vascular, Santa Clara, US) and was successfully discharged.The 48-year-old woman with right breast cancer was admitted for mastectomy and breast reconstruction.She had no past medical history.Post-operatively, she developed acute chest pain and hypotension.Electrocardiogram showed anterior ST-segment elevation, and the cardiac catheterisation laboratory was activated.During the procedure, she had recurrent collapse from ventricular arrhythmias requiring cardiopulmonary resuscitation and repeated defibrillation.Intra-aortic balloon pump (IABP) was inserted and coronary angiography showed isolated LM coronary artery occlusion (Figs.1A and1B).After aspiration thrombectomy, a 3.5 x 18mm stent was implanted from LM into proximal left anterior descending (LAD) artery (Figs.1C and1D) establishing Thrombolysis in Myocardial Infarction (TIMI) 3 flow.In view of haemodynamic and electrical instability, ECMO was implanted.Transthoracic echocardiogram (TTE) showed severely depressed left ventricular ejection fraction (LVEF) of 15-20% with trivial MR.She was transferred back to the intensive care unit (ICU) and her stay was complicated by acute kidney injury requiring renal replacement therapy, abdominal haematoma requiring surgical evacuation and pneumonia.Inotropes were weaned off gradually and the ECMO was successfully explanted on day 8 of myocardial infarction.In view of the prolonged stay and ventilation required, she underwent a tracheostomy.However, despite adequate ultrafiltration, she had recurrent acute pulmonary oedema and was unable to come off the ventilator.She developed hypotension