3D Printing-Guided Occlusion of Large Leaflet Perforation

Mitral regurgitation (MR) secondary to leaflet perforation after transcatheter edge-to-edge repair (TEER) is a rare yet critical complication requiring careful evaluation and management.

A 75-year-old male with coronary artery disease underwent TEER for severe functional MR. Postprocedure, recurrent MR due to a large anterior leaflet perforation in the A2 region was observed. A three-dimensional (3D)-printed model revealed the perforation size was significantly larger than echocardiographic measurements, underscoring the necessity of precise device sizing for effective occlusion.

This case highlights the risk of leaflet perforation post-TEER, likely due to tension release during the procedure. Loss of leaflet insertion on echocardiography may indicate perforation. The use of 3D-printed models provided critical insights into perforation morphology, enhancing procedural planning and demonstrating the value of advanced imaging techniques in complex cases.

This case emphasizes the importance of device oversizing for large perforations and the role of patient-specific 3D modeling in optimizing TEER outcomes, offering potential value for procedural planning and complication management.