ArticleEuropean heart journal. Case reports2025
Transcatheter edge-to-edge repair for complex mitral regurgitation: a case report of prolapse with leaflet perforation.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Management and Imaging Strategies in Pediatric Infective Endocarditis With Mitral Prolapse.JACC. Case reports · 2026Article
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5 authors.
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Abstract
Background: Transcatheter edge-to-edge repair (TEER) is an established treatment for high-risk surgical candidates with severe mitral regurgitation (MR). However, its application in cases with leaflet perforation is rarely reported. Case summary: An 86-year-old woman presented with worsening dyspnoea. Transthoracic echocardiography revealed severe primary MR with P2 prolapse. Transoesophageal echocardiography (TOE) demonstrated chordae tendineae rupture and a 2.8 mm wide perforation at P2, suggestive of healed infective endocarditis. The distance from the tip of P2 in front of the perforation and the far end was measured to be ∼5.0 and 7.0 mm, measured using 3D multi-planar reconstruction. Given the patient's high surgical risk, TEER was planned after careful heart team discussion. The procedure successfully achieved intended grasping on the first attempt using one MitraClip® (XTW), reducing MR to mild without leaflet injury. One-week follow-up echocardiography showed no leaflet injuries or single leaflet device attachment. The patient's heart failure symptoms improved, with no recurrence or infection for a year. Discussion: Although TEER is not primarily recommended for MR with a perforation even in a patient at high surgical risk, this case demonstrates that TEER can be a viable option for high surgical risk patients with mitral valve prolapse and perforation when guided by detailed pre-operative TOE evaluation and careful heart team decision-making. The proximity of perforation to leaflet edge and use of appropriate clip size were crucial for successful repair.
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