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IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
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Updated: Dec 20, 2025

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Mitral valve perforation during transcatheter aortic valve replacement.

Shotaro Higa1, Takaaki Nagano1, Satoshi Yamashiro1

  • 1Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.

Asian Cardiovascular & Thoracic Annals
|June 2, 2020
PubMed
Summary

Transcatheter aortic valve replacement (TAVR) is a popular procedure for severe aortic stenosis. A rare complication of TAVR is mitral valve perforation, requiring immediate open conversion for repair.

Keywords:
Aortic valve stenosiscardiac catheterizationheart injuriesheart valve prosthesis implantationmitral valvetranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis, particularly in high-risk patients.
  • While TAVR offers a less invasive approach, potential complications require careful monitoring and management.
  • Mitral valve integrity is crucial for overall cardiac function, and iatrogenic injury can have significant consequences.

Observation:

  • An 86-year-old female underwent TAVR using a balloon-expandable valve.
  • During the procedure, the balloon catheter shifted, leading to an unexpected complication.
  • Intraoperative transesophageal echocardiography identified a new-onset severe mitral regurgitation.

Findings:

  • A 5-mm perforation was discovered in the anterior mitral leaflet.
  • The mitral valve injury necessitated immediate conversion to open-heart surgery.
  • Successful direct closure of the mitral valve perforation was performed.

Implications:

  • This case highlights a rare but serious complication associated with TAVR.
  • It underscores the importance of vigilant intraoperative monitoring for iatrogenic cardiac injuries.
  • Prompt recognition and surgical intervention are critical for managing mitral valve perforation post-TAVR.