Paradoxical Left-to-Right Device Embolization Complicating Transcatheter Mitral Valve Edge-to-Edge Repair

Figures

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  Figure 1. Pre-Transcatheter Mitral Valve Edge-to-Edge Repair Transesophageal Echocardiogram (A) 3-dimensional image of the mitral valve demonstrating a broad P2 prolapse (arrow). (B) 2-dimensional color image demonstrating torrential mitral regurgitation.

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  Figure 2. Post-Transcatheter Mitral Valve Edge-to-Edge Repair Fluoroscopy and Transesophageal Echocardiogram (A) Fluoroscopy demonstrating 3 deployed mitral transcatheter edge-to-edge repair clips (arrows). (B) 3-dimensional transesophageal echocardiogram demonstrating 3 deployed mitral transcatheter edge-to-edge repair clips (arrows). (C) Color Doppler transesophageal echocardiogram demonstrating mild-moderate residual mitral regurgitation.

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  Figure 3. Investigations to Locate the Embolized Transcatheter Mitral Valve Edge-to-Edge Repair Clip (A) Chest radiograph with only 2 visible mitral valve edge-to-edge repair clips (arrows). (B) Computed tomography chest, abdomen, and pelvis in the coronal (top) and axial planes (bottom) localizing the embolized clip to the left groin (arrows). (C) Color Doppler ultrasound of the groin confirmed the position of the embolized clip in the left common femoral vein (arrow).

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  Figure 4. Repeat 3-Dimensional Transesophageal Echocardiogram of the Interatrial Septum A large slit-like iatrogenic atrial septal defect is demonstrated (arrow).

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  Figure 5. Post-Redo Transcatheter Mitral Valve Edge-to-Edge Repair Fluoroscopy and Transesophageal Echocardiogram (A) Fluoroscopy demonstrating 1 mitral TEER clip replaced at the site of the previously embolized clip (arrow). (B) Color Doppler TOE demonstrating the unidirectional left-to-right residual atrial septal defect that was not intervened. (C) Color Doppler TOE demonstrating multiple jets of overall moderate residual mitral regurgitation.