Key result
PASCAL TEER demonstrates safe deployment for medial commissure flail via targeted transseptal puncture.
Why the study?
The study was conducted to describe transcatheter edge-to-edge mitral valve repair using the PASCAL device in patients with medial commissure flail-induced primary mitral regurgitation.
Can the PASCAL device be safely deployed for transcatheter edge-to-edge mitral valve repair in a patient with medial commissure flail?
Case Report (n=1)
Can the PASCAL device be safely deployed for transcatheter edge-to-edge mitral valve repair in a patient with medial commissure flail?
This report demonstrates a specific procedural technique for safely deploying the PASCAL device in patients with medial commissure flail-induced primary mitral regurgitation.
May guide technique in select commissural cases; hypothesis-generating and should not change practice.
OBJECTIVES: The aim of this report is to describe transcatheter edge-to-edge mitral valve repair using the PASCAL device in patients with medial commissure (MC) flail-induced primary mitral regurgitation. KEY STEPS: Perform a transseptal puncture above the MC. Insert the guide sheath (GS) into the left atrium (LA), guide the steerable catheter (SC) into the GS, and direct it toward the mitral valve. Withdraw the GS to the right atrium while maintaining the SC in the LA to approach the MC. Adjust the anterior-posterior trajectory using the GS flex knob. After leaflet grasping and PASCAL deployment, readvance the GS over the SC into the LA. POTENTIAL PITFALLS: Without a GS backup, the SC may become parallel to the aorta, hindering anterior leaflet visualization and complicating grasping. TAKE-HOME MESSAGES: The PASCAL device can be deployed safely even if the GS is withdrawn to the right atrium. Performing a transseptal puncture directly above the MC is essential to guide the SC when retracted.
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Enta et al. (2025) conducted a case report in Medial commissure flail-induced primary mitral regurgitation (n=1). Transcatheter edge-to-edge mitral valve repair using PASCAL system was evaluated. Transcatheter edge-to-edge mitral valve repair using the PASCAL device can be deployed safely for medial commissure flail by performing a transseptal puncture directly above the medial commissure.
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