Early postoperative anterior leaflet tear following third transcatheter edge-to-edge mitral valve repair confirmed by autopsy

We report a case of early postoperative anterior mitral leaflet tear following a third transcatheter edge-to-edge mitral valve repair (TEER) procedure in a patient with dilated cardiomyopathy and heart failure with reduced ejection fraction. The patient, who had previously undergone two TEER procedures, developed recurrent mitral regurgitation (MR) and subsequently underwent a third TEER. However, after the third TEER, the MR worsened on postoperative day 3. Due to haemodynamic instability, repeat transoesophageal echocardiography could not be performed. The patient died 7 months later. Autopsy revealed a large anterior leaflet tear near the third clip site, with differential endothelialisation between the third and earlier clips. This case highlights the risk of early postoperative leaflet injury following multiple TEER procedures and underscores the importance of careful patient selection and procedural planning in complex heart failure cases.