Key result
PASCAL TEER reduces severe mitral regurgitation to trace in a functionally trileaflet valve.
Why the study?
A trileaflet mitral valve is an uncommon anatomical finding that presents unique challenges for transcatheter repair.
Does transcatheter edge-to-edge repair reduce mitral regurgitation in a patient with a functionally trileaflet mitral valve?
Case Report (n=1)
Does transcatheter edge-to-edge repair reduce mitral regurgitation in a patient with a functionally trileaflet mitral valve?
Transcatheter edge-to-edge repair using the PASCAL system can be successfully adapted to treat severe mitral regurgitation in patients with complex, unconventional trileaflet-appearing mitral valve anatomy.
Answers are grounded in this paper and cite their sources.
TEER succeeded in one trileaflet case; hypothesis-generating and should not yet change practice.
BACKGROUND: A trileaflet configuration of the mitral valve is an uncommon anatomical finding that presents unique challenges for transcatheter repair. CASE SUMMARY: A 67-year-old man with a history of atrioventricular canal defect and prior mitral valve repair presented with symptomatic severe mitral valve insufficiency due to impaired leaflet coaptation from a cleft dividing the A2 scallop, creating a functionally trileaflet mitral valve. Given elevated surgical risk and patient preference to avoid reoperation, transcatheter edge-to-edge repair with the 2 PASCAL ACE system devices (Edwards Lifesciences) was successfully performed allowing restoration of coaptation and reduced mitral insufficiency to trace severity with a final transmitral mean gradient of 3 mm Hg. DISCUSSION: This case highlights the adaptability of transcatheter edge-to-edge repair in unconventional mitral valve anatomy. TAKE-HOME MESSAGE: Complex trileaflet or cleft mitral valves should not preclude transcatheter repair when guided by appropriate imaging and device strategy.
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Ali et al. (2026) conducted a case report in Severe mitral valve insufficiency (n=1). Transcatheter edge-to-edge repair with PASCAL ACE system was evaluated on Mitral regurgitation severity and transmitral mean gradient. Transcatheter edge-to-edge repair using two PASCAL ACE devices successfully reduced severe mitral insufficiency to trace severity with a final transmitral mean gradient of 3 mm Hg in a patient with a functionally trileaflet mitral valve.
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