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Percutaneous Edge-to-Edge Repair as a Bailout Option to Treat Iatrogenic Leaflet Perforation
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OVERVIEW
An 80-year-old man was referred to our center for heart failure and severe degenerative mitral regurgitation (MR). Transesophageal echocardiography revealed severe MR due to anterior leaflet prolapse, mainly in its central portion (A2) in the context of fibroelastic deficiency (Panel A,B). Percutaneous edge-to-edge repair was chosen by the Heart Team due to high surgical risk. Using a wide MitraClip G4 XTW (Abbott Vascular), a good grasp with appropriate leaflet insertion and MR reduction to mild was obtained (Panel C,D; Video 1). Shortly afterwards, just before clip release, echocardiography revealed the appearance of a massive regurgitant jet due to a posterior leaflet perforation/laceration just posteriorly to the clip (Panel E,F; Video 2). The patient developed hemodynamic instability with an urgent treatment required. The wide MitraClip was then reopened and a new leaflet grasp included the laceration inside the grasping zone with mild-to-moderate residual MR (Panel G,H; Video 3). Considering the previous laceration, mild-to-moderate residual MR was considered acceptable.
These images underline that a wide posterior leaflet grasp in the context of a fragile leaflet may cause traction forces on the leaflet, which may cause perforation/laceration. Although MitraClip procedure is usually contraindicated in case of leaflet perforation, it can be considered as a bailout treatment option as long as the laceration area is not too far from the leaflet rim and can be included in the grasped area.
Affiliations and Disclosures
From 1 Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy, 2 Cardiothoracovascular Department, University of Trieste, Trieste, Italy, 3Interventional Cardiology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan, Italy
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein. The authors affirm that the images have not been previously published.
Address for Correspondence: Dr. Francesco Giannini, MD, IRCCS Galeazzi Sant’Ambrogio, Milan, Italy, Via Cristina Belgioioso 173, 20161, Milan, Italy, Email: giannini_fra@yahoo.it
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See the case videos here: Percutaneous Edge-to-Edge Repair as a Bailout Option to Treat Iatrogenic Leaflet Perforation
