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Updated: Apr 23, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Retrieval of a Free-Floating Transcatheter Edge-to-Edge Repair Clip in a Giant Left Atrium
Ruitao Hou1, Munire Zaibi2, Jiayi Weng1
1Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China.
Background:
Device embolization during transcatheter edge-to-edge repair is a rare and catastrophic complication. Retrieval can be particularly challenging in a giant left atrium (LA), where jet-driven device motion may render active "chasing" ineffective.
Case Summary:
A DragonFly clip completely detached in a 75-year-old man with a giant LA (anteroposterior diameter ∼10 cm). The device moved erratically, driven by eccentric regurgitant jets, making active pursuit unsuccessful. We switched to a fluoroscopy-guided passive capture strategy after identifying a consistent turning/impact zone on the lateral atrial wall. The snare was stationed at this specific site to await and intercept the recirculating clip, which allowed for subsequent orientation and atraumatic extraction.
Discussion:
This case illustrates the use of a practical "floating clip" phenomenon in a giant LA. When fluoroscopy demonstrates a repeatable device trajectory, passive capture at a reproducible turning/impact zone may facilitate device retrieval and support continued percutaneous management in selected cases.
