Key result
3D printing-guided plug occlusion successfully reduces severe post-TEER mitral regurgitation to mild.
Why the study?
Mitral regurgitation secondary to leaflet perforation after TEER is a rare but critical complication requiring careful evaluation and management, with challenges in accurate perforation sizing for device occlusion.
Can 3D printing-guided transcatheter occlusion safely and effectively reduce severe mitral regurgitation caused by leaflet perforation post-TEER?
Case Report (n=1)
Can 3D printing-guided transcatheter occlusion safely and effectively reduce severe mitral regurgitation caused by leaflet perforation post-TEER?
Patient-specific 3D printing accurately evaluates the size and irregular shape of post-TEER leaflet perforations, ensuring correct device oversizing for successful transcatheter occlusion.
May offer bailout option for post-TEER leaflet perforation; hypothesis-generating and requires prospective validation.
BACKGROUND: Mitral regurgitation (MR) secondary to leaflet perforation after transcatheter edge-to-edge repair (TEER) is a rare yet critical complication requiring careful evaluation and management. CASE SUMMARY: A 75-year-old male with coronary artery disease underwent TEER for severe functional MR. Postprocedure, recurrent MR due to a large anterior leaflet perforation in the A2 region was observed. A three-dimensional (3D)-printed model revealed the perforation size was significantly larger than echocardiographic measurements, underscoring the necessity of precise device sizing for effective occlusion. DISCUSSION: This case highlights the risk of leaflet perforation post-TEER, likely due to tension release during the procedure. Loss of leaflet insertion on echocardiography may indicate perforation. The use of 3D-printed models provided critical insights into perforation morphology, enhancing procedural planning and demonstrating the value of advanced imaging techniques in complex cases. TAKE-HOME MESSAGE: This case emphasizes the importance of device oversizing for large perforations and the role of patient-specific 3D modeling in optimizing TEER outcomes, offering potential value for procedural planning and complication management.
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Yang et al. (2025) conducted a case report in Mitral regurgitation secondary to leaflet perforation after transcatheter edge-to-edge repair (n=1). 3D printing-guided transcatheter occlusion (Amplatzer Vascular Plug II) was evaluated on Reduction in mitral regurgitation severity. 3D printing-guided transcatheter occlusion using an appropriately oversized 16-mm Amplatzer Vascular Plug II successfully reduced severe post-TEER mitral regurgitation to mild.
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