Tear of Posterior Mitral Valve Leaflet During MitraClip, Successful Bailout Using Vascular Plugs

Figures

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  Figure 1. Mitral Clip Procedure and the Bailout With Vascular Plugs (A) Released first clip, mild lateral mitral regurgitation (MR). (B) Three-dimensional view showing the 2 mitral valve (MV) orifices after the first clip. (C) Unplanned release of the second clip due to trapping at medial commissure, moderate MR between both clips. (D) Severe MR after the release of the third clip. (E) First Amplatzer vascular plug (AVP) 16-mm device deployed, moderate residual MR. (F) Second AVP 12-mm device deployed, mild residual MR. See Videos 1, 2, 3, and 4.

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  Figure 2. 3D Zoom and Fluoroscopy of TAIBA Technique (A) Three-dimensional zoom surgical view shows the transseptal wire passing through the medial commissure medial to the 3 clips. (B and C) Deployment of AVP and its release. (D) Released both AVPs. 1 and 2 refer to the first and second vascular plugs. (E) Three clips and deployment of the first AVP. (F) Deployment of the second AVP. See Videos 5 and 6. LAA = left atrial appendage; other abbreviations as in Figure 1.

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  Figure 3. Follow-Up TTE After 1 Year (A) Parasternal long-axis view of the medial half of the MV shows the collection of the 3 clips and the 2 devices. (B) Parasternal long-axis view of the lateral half of the MV shows mild residual MR. (C and D) Apical 4-chamber view shows the clips and the devices, mild residual MR. (E) Apical 3-chamber view shows mild residual MR. (F) Parasternal short-axis view shows the lateral orifice of the MV, the medial half closed by the clips and devices. See Videos 7, 8, 9, 10, and 11. TTE = transthoracic echocardiography; other abbreviations as in Figure 1.