What is the clinical evidence from this study?

Study design: Case Report. Population: Symptomatic severe mitral valve insufficiency with functionally trileaflet mitral valve (n=1). Intervention: Transcatheter edge-to-edge repair with PASCAL ACE system. Primary outcome: Reduction of mitral insufficiency and final transmitral mean gradient.

What does this research mean for the field?

Transcatheter edge-to-edge repair using PASCAL ACE devices can successfully reduce severe mitral insufficiency in patients with complex, functionally trileaflet mitral valves. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to explore the feasibility of transcatheter repair in patients with functionally trileaflet mitral valves, addressing unique anatomical challenges.

July 5, 2026JACC Case Reports0 citationsOpen Access

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Transcatheter Edge-to-Edge Repair of a Functionally Trileaflet Mitral Valve

TAToheed-Fatima AliSt. Rita's Medical Center HGHafez GolzarianMemorial Hermann MKMallory KnousSt. Rita's Medical Center

Key Result

Transcatheter edge-to-edge repair using PASCAL ACE devices successfully reduced severe mitral insufficiency to trace severity with a 3 mm Hg mean gradient in a patient with a trileaflet valve.

Key Points

This study aims to explore the feasibility of transcatheter repair in patients with functionally trileaflet mitral valves, addressing unique anatomical challenges.
67-year-old male with a history of atrioventricular canal defect and prior mitral valve repair diagnosed with severe mitral valve insufficiency.
Transcatheter edge-to-edge repair performed using the 2 PASCAL ACE system devices (Edwards Lifesciences).
Follow-up measurements included transmitral mean gradient post-procedure.
Mitral insufficiency severity reduced to trace after the procedure.
Final transmitral mean gradient measured at 3 mm Hg, indicating successful intervention.
Demonstrates adaptability of transcatheter repair in unique mitral valve anatomies.

Study Design

Type

Case Report (n=1)

Structured PICO

Does transcatheter edge-to-edge repair improve mitral insufficiency in a patient with a functionally trileaflet mitral valve?

Population

A 67-year-old man with symptomatic severe mitral valve insufficiency and a functionally trileaflet mitral valve due to a cleft A2 scallop.

Intervention

Transcatheter edge-to-edge repair (TEER) using 2 PASCAL ACE system devices.

Outcome

Restoration of coaptation, reduction in mitral insufficiency severity, and final transmitral mean gradient.surrogate

Transcatheter edge-to-edge repair can be successfully and safely performed in patients with complex, functionally trileaflet mitral valve anatomy.

Abstract

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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Cite This Study

Ali et al. (Wed,) conducted a case report in Symptomatic severe mitral valve insufficiency with functionally trileaflet mitral valve (n=1). Transcatheter edge-to-edge repair with PASCAL ACE system was evaluated on Reduction of mitral insufficiency and final transmitral mean gradient. Transcatheter edge-to-edge repair using PASCAL ACE devices successfully reduced severe mitral insufficiency to trace severity with a 3 mm Hg mean gradient in a patient with a trileaflet valve.

synapsesocial.com/papers/6a4a15a0762f9565a042748c https://doi.org/https://doi.org/10.1016/j.jaccas.2026.109181

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