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Updated: Apr 4, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter edge-to-edge repair for severe mitral regurgitation in a patient with a massive left atrium: a case
Qingwei Ni1, Zhijie Mao1, Changxi Chen1
1Department of Cardiovascular Medicine, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou, Zhejiang 325000, China.
Background:
Transcatheter edge-to-edge repair (TEER) poses significant technical challenges in patients with a massive left atrium (LA), where conventional anatomical criteria often deem the procedure unsuitable.
Case Summary:
A 77-year-old man, at prohibitive surgical risk, presented with a giant LA (113 × 129 × 133 mm) and severe mitral regurgitation (MR). After pacemaker implantation, TEER was performed. Despite suboptimal echocardiographic windows and challenging leaflet capture, a tailored posteroinferior transseptal puncture 4.67 cm above the mitral annular plane provided a stable trajectory, enabling successful navigation and deployment of three MitraClip devices (Abbott, Santa Clara, CA, USA). The procedure achieved an excellent outcome with a mean gradient of 5 mmHg and only mild residual MR. Marked left atrial reverse remodelling and symptomatic improvement were observed at 1-month follow-up.
Discussion:
This case demonstrates that TEER is a viable and effective intervention for patients with extreme LA enlargement, challenging conventional anatomical selection criteria. Success hinges on technical precision-particularly an optimized transseptal puncture-and prioritizing favourable haemodynamic outcomes over rigid anatomic thresholds.
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