Late-Onset Embolization of a Mitral Transcatheter Edge-to-Edge Repair Device

Figure 1. Echocardiography Images Showing Displaced MitraClip in the RCC of the Aorta Images on (Left and Right) transthoracic echocardiography and (Center) transesophageal echocardiography demonstrating the embolized MitraClip device (red circles) located in the RCC of the aortic root. The clip appears as a highly echogenic, mobile structure distinct from the native valvular apparatus. Imaging was critical in identifying the clip's location after suspected detachment. RCC = right coronary cusp.

Figure 2. Initial Attempt to Retrieve the Dislodged MitraClip by Aneri Forceps Fluoroscopic anteroposterior image demonstrating the radio-opaque MitraClip device located within the right coronary cusp of the aortic root. The clip is visualized as a distinct metallic structure separate from the coronary catheters and guidewires. This imaging confirmed the location of the embolized device before the initial retrieval attempt with Aneri forceps.

Figure 3. Attempt to Retrieve Embolized MitraClip Into the Sheath Fluoroscopic anteroposterior image demonstrating an attempt to retrieve the embolized MitraClip device into the 24-F vascular sheath with Aneri forceps. The clip is visualized engaged by the forceps within the ascending aorta during percutaneous retrieval efforts and moved toward the vascular sheath.

Figure 4. Dislodgement of MitraClip Back Into the Descending Aorta Fluoroscopic anteroposterior image showing migration of the MitraClip device back into the descending thoracic aorta after an unsuccessful retrieval attempt. The metallic clip is visualized proximal to the diaphragm, separate from the vascular sheath and retrieval device.

Figure 5. Retrieving the MitraClip With the Snare and Advancing It Into the Sheath (A) Fluoroscopic anteroposterior image showing the final retrieval attempt of the embolized MitraClip using a snare device within the descending aorta. (B) Subsequent advancement of the captured MitraClip into the vascular sheath under continuous fluoroscopic guidance, confirming successful percutaneous retrieval.

Figure 6. Balloon Inflation of the Right Common Iliac Artery to Secure Hemostasis Fluoroscopic anteroposterior image demonstrating balloon inflation within the right common iliac artery to achieve vascular hemostasis after percutaneous retrieval of the MitraClip device. The balloon is advanced on a J-tip wire introduced through left femoral access, positioned across the right femoral access site, and inflated under imaging guidance to control bleeding.

Figure 7. Successful Repeat MitraClip Placement Transesophageal echocardiography midesophageal 2-chamber view demonstrating the newly deployed MitraClip securely grasping both anterior and posterior mitral leaflets. Color Doppler imaging confirmed minimal residual mitral regurgitation with stable clip position.