Vascular Plug Closure of Delayed Leaflet Perforation Post-TEER in Patient With Multiple Implantable Devices

BACKGROUND: Transcatheter edge-to-edge repair (TEER) is the main minimally invasive therapy for severe mitral regurgitation (MR) in patients at high surgical risk. Roughly 10% of patients develop recurrent MR within 1 year postoperatively. Postprocedural mitral anatomical distortion complicates reintervention, rendering recurrent MR management a common clinical challenge. CASE SUMMARY: A 63-year-old man with multivalvular heart disease, chronic heart failure, multiple implantable devices and dialysis-dependent end-stage renal disease presented with symptomatic severe recurrent MR secondary to delayed anterior mitral leaflet perforation after TEER. Under combined fluoroscopic and 3-dimensional transesophageal echocardiographic guidance, our multidisciplinary team performed transcatheter closure of the perforation using a vascular plug. MR was markedly alleviated, heart failure symptoms resolved, and the patient recovered uneventfully before discharge. DISCUSSION: TEER-related leaflet perforation caused severe recurrent MR. Percutaneous plug closure successfully downgraded MR to trivial, confirming the feasibility of this approach for mitral leaflet perforation.