Subacute Embolization of Transcatheter Mitral Valve Repair Clip to the Noncoronary Sinus Presenting as Decompensated...

Mitral clip detachment with embolization is an exceedingly rare complication with an incidence rate of <0.1%. Our case report describes a patient with subacute MitraClip (Abbott) embolization into the noncoronary sinus (NCS).

Our patient was an 84-year-old man with a history of heart failure with preserved ejection fraction and severe mitral regurgitation requiring transcatheter-edge-to-edge repair with 3 MitraClips 2 weeks before presentation. He presented with acute decompensated heart failure with an elevated pro-B-type natriuretic peptide value (5,883 pg/mL), a chest radiograph revealing a displaced clip, and a transthoracic echocardiogram confirming severe mitral regurgitation with a flail leaflet. Eventually, a transesophageal echocardiogram revealed embolization to the NCS.

Using a heart team approach in addition to palliative care, we discussed surgical and nonsurgical options. Despite his high surgical risk, the patient preferred a surgical approach. The MitraClip was successfully retrieved, and a mitral bioprosthesis was implanted.

MitraClip embolization is rare, with limited understanding of risk factors and optimal management strategy. Risk factors may include suboptimal intraoperative images, technical challenges, and complex anatomy. Management requires a heart team approach with consideration for palliative care involvement.