Transcatheter Edge-to-Edge Mitral Valve Repair Device Embolization into the Right Lower Pulmonary Vein

Excellent efficacy and safety have led to an increase in transcatheter edge-to-edge repair (TEER) procedures. MitraClip embolization into the pulmonary veins has not yet been reported in the literature.

A 77-year-old man in cardiogenic shock with severe mitral regurgitation underwent a MitraClip procedure. Deployment of a second MitraClip was complicated by knotting of the locking threads. Attempts to release these threads led to embolization of the MitraClip into the right lower pulmonary vein. Transesophageal echocardiography-guided retrieval using a gooseneck snare through a multipurpose catheter led to safe clip removal.

MitraClip embolization is a rare event that complicates up to 0.1% of cases. This is to our knowledge the first case report on embolization into the pulmonary veins. Lock-thread failure as the mechanism for embolization is uncommon. Our retrieval assembly, consisting of a gooseneck snare through a long multipurpose catheter then through the MitraClip steerable catheter, provided adequate reach, torque, and maneuverability for safe retrieval.

The pulmonary veins are a rare location for MitraClip embolization. Appropriate catheter selection and optimal grasp orientation are key to event-free retrieval.