Transcatheter Edge-to-Edge Mitral Valve Repair Device Embolization into the Right Lower Pulmonary Vein.

Figures

• 

  Figure 1. Transesophageal Echocardiography Images Confirming Severe Eccentric Mitral Regurgitation (A) Overriding anterior leaflets due to posterior leaflet tethering. (B) Color Doppler flow with severe regurgitation. (C) Three-dimensional image of coaptation gap during mitral valve closure in systole. (D) Three-dimensional color Doppler of mitral regurgitation in systole.

• 

  Figure 2. Echocardiographic Images Showing Different Stages of the Initial XTW MitraClip Placement (A) Two- and three-dimensional images showing transseptal puncture during TEER procedure: (B) Two-dimensional and color Doppler images showing successful deployment of the first XTW MitraClip with moderate residual mitral regurgitation. (C) Three-dimensional images showing successful deployment of the first XTW MitraClip with moderate residual mitral regurgitation. TEER = transcatheter edge-to-edge repair.

• 

  Figure 3. Simplified Schematic Diagram Depicting the Function, Normal Removal, and Mechanism of Functional Failure of the Lock Thread in the G4 MitraClip Delivery System

• 

  Figure 4. Fluoroscopic and Echocardiographic Images Depicting Events Leading to Embolization of MitraClip Into Right Lower Pulmonary Vein Fluoroscopic images showing (A) second MitraClip deployment next to the first MitraClip, with the delivery system across the mitral valve; (B) the delivery system retracted, with the second clip unstable next to the first clip on fluoroscopy; and (C) the second MitraClip embolized into the right lower pulmonary vein (arrow). (D) Two-dimensional echocardiogram showing the embolized MitraClip in the lower right pulmonary vein.

• 

  Figure 5. Fluoroscopic and Echocardiographic Images Depicting Events During Retrieval of Embolized MitraClip From Right Lower Pulmonary Vein (A) Fluoroscopic image showing a 10 mm gooseneck snare through multipurpose catheter directed at the embolized MitraClip. (B) Fluoroscopic image showing the gooseneck snare securely holding the neck of the MitraClip and pulled inside the steerable catheter. (C) Two-dimensional echocardiogram showing the MitraClip at the tip of the catheter and the snare assembly being pulled across the interatrial septostomy. (D) Two-dimensional TEE with color Doppler showing iatrogenic atrial septal defect after the clip and catheters have been pulled out of the interatrial septostomy. TEE = transesophageal echocardiography.

• 

  Visual Summary. Timeline of the Case EF = ejection fraction; IABP = intra-aortic balloon pump; IV = intravenous; LVEF = left ventricular ejection fraction; STS = Society of Thoracic Surgeons; TEE = transesophageal echocardiography; TEER = transcatheter edge-to-edge repair; TTE = transthoracic echocardiography.