Key result
TEER with MitraClip successfully reduces severe MR to mild in posterior leaflet perforation.
Why the study?
Mitral valve leaflet perforation is generally considered unsuitable for transcatheter edge-to-edge repair, with limited published experience mainly in bailout treatment of iatrogenic perforations.
Does transcatheter edge-to-edge repair (TEER) reduce mitral regurgitation in a patient with severe symptomatic MR and a large posterior mitral leaflet perforation?
Case Report (n=1)
Does transcatheter edge-to-edge repair (TEER) reduce mitral regurgitation in a patient with severe symptomatic MR and a large posterior mitral leaflet perforation?
This case demonstrates the feasibility of using MitraClip for primary treatment of mitral leaflet perforation when guided by 3D transesophageal echocardiography.
BACKGROUND: Mitral valve leaflet perforation is generally considered unsuitable anatomy for transcatheter edge-to-edge repair (TEER), with published experience largely limited to bailout treatment of iatrogenic perforations. CASE SUMMARY: A 75-year-old man with severe symptomatic mitral regurgitation (MR) was referred for TEER. Intraprocedural transesophageal echocardiogram (TEE) unexpectedly revealed a large posterior mitral leaflet perforation. Guided by 3D multiplanar reconstruction imaging, 2 XTW MitraClip devices were deployed on both sides of the perforation, effectively "sandwiching" the defect between the clips and reducing MR from severe to mild. DISCUSSION: This case supports the feasibility of MitraClip as a primary treatment for mitral leaflet perforation in carefully selected patients. TEE with 3D multiplanar reconstruction imaging enabled accurate anatomic characterization and facilitated precise device positioning, resulting in an excellent procedural outcome. TAKE-HOME MESSAGES: Mitral valve leaflet perforation may be amenable to TEER in select cases. 3D TEE imaging is critical for procedural planning and helps to facilitate precise device positioning.
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Shen et al. (2026) conducted a case report in Severe symptomatic mitral regurgitation with mitral valve leaflet perforation (n=1). Transcatheter edge-to-edge repair (TEER) with MitraClip was evaluated on Reduction in mitral regurgitation severity. Transcatheter edge-to-edge repair using 2 MitraClip devices successfully reduced mitral regurgitation from severe to mild in a 75-year-old man with a posterior leaflet perforation.
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