Massive esophageal hemorrhage after a MitraClip procedure successfully treated by balloon compression
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CASE REPORT
Massive esophageal hemorrhage after a MitraClip procedure successfully treated by balloon compression Ippei Tanaka1 · Hiroaki Saito1 · Tomoki Matsuda1 · Takashi Matsumoto2 · Yoshiko Munehisa2 · Rie Fujii1 · Dai Hirasawa1 Received: 19 March 2020 / Accepted: 3 June 2020 © Japanese Society of Gastroenterology 2020
Abstract MitraClip procedure is an effective treatment for mitral regurgitation, performed globally. During the MitraClip procedure, transesophageal echocardiography is an essential modality to perform the operation safely. Although a few transesophageal echocardiography-related complications, such as esophageal hematoma, have been reported, there are no reports on massive esophageal bleeding after the MitraClip procedure. We present the first case of massive esophageal hemorrhage caused by transesophageal echocardiography after a MitraClip procedure and the successful treatment by balloon compression using a Sengstaken–Blakemore tube. Keywords Esophageal hemorrhage · Mitraclip · Transesophageal echocardiography · Sengstaken–Blakemore tube
Introduction
Case report
In recent years, with the development of medical devices, catheter treatment for mitral valve and aortic valve disease for the purpose of improving heart failure has become popular. Particularly, the usefulness of the MitraClip procedure, which is a treatment for mitral regurgitation (MR), has been established as a safe procedure, with the number of its applications rising worldwide. Transesophageal echocardiography (TEE) is an essential imaging modality during the MitraClip procedure. Although TEE has been established as a safe procedure, several complications, such as esophageal hematoma and perforation, have been reported [1]. This paper describes a rare case of TEE-induced massive esophageal hemorrhage following a MitraClip procedure, which was successfully treated by balloon compression.
A 75-year-old man was referred to our hospital for treatment of MR. His medical history included hypertension and percutaneous coronary intervention for coronary artery disease 5 months ago. MR severity was classified as “severe”, based on transthoracic echocardiography results. He orally administered aspirin and clopidogrel sulfate. The laboratory examination was within the normal range, including platelet count and international normalized ratio. Because he was a geriatric with a history of coronary artery disease, surgical treatment was considered impossible. Thus, he underwent a MitraClip procedure (Abbott Vascular Co., Ltd., Tokyo, Japan) for severe MR, with continued administration of antiplatelet drugs. During the procedure, the TEE probe (Aloka SSD-2200, Tokyo, Japan) was placed in the upper part of the esophagus to observe the inside of the heart, and to confirm the operation of the catheter and the placement of the clip. The TEE-guided MitraClip procedure was performed in a standard way under general anesthesia with a duration of about 2 h. When the TEE probe was removed after successful replacement of MitraClip, a massive amount o
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