A Challenging Redo Mitral Clip Procedure in a Complex Clinical Scenario

Transcatheter edge-to-edge repair (TEER) is pivotal for high-risk, severe mitral regurgitation. Redo TEER remains challenging, particularly with prior structural interventions such as atrial septal defect (ASD) closure complicating access and maneuverability.

A 60-year-old man with severe functional mitral regurgitation and nonischemic dilated cardiomyopathy underwent redo TEER following clinical deterioration after a previous procedure. A previously implanted ASD occluder posed a significant anatomical challenge, however trans-septal puncture was successfully achieved adjacent to the ASD occluder without traversing or damaging it. The novel access approach allowed completion of the procedure without complications.

This case highlights the feasibility of redo TEER in patients with prior ASD occluder and underscores the critical importance of careful preprocedural planning, precise trans-septal puncture, and meticulous device handling to optimize procedural success.

Redo TEER with prior ASD occluder is feasible with advanced imaging, planning, and multidisciplinary collaboration.