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08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Successful Mitral Valve Repair for Single Leaflet Device Attachment Following Transcatheter Edge-to-Edge Repair: A
Takuro Makiura1, Masahiro Daimon1, Takahiro Katsumata1
1Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan, ompu.ac.jp.
Case Reports in Cardiology
|June 24, 2026
Summary
Transcatheter edge-to-edge repair (TEER) complications like single leaflet device attachment (SLDA) may require complex surgery. En bloc resection with leaflet excision is often necessary for recurrent mitral regurgitation after TEER.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter edge-to-edge repair (TEER) using devices like the MitraClip NT︎ is a treatment for severe mitral regurgitation (MR).
- Complications such as single leaflet device attachment (SLDA) can lead to recurrent MR and necessitate further intervention.
- Late-phase SLDA poses technical challenges for isolated device removal due to tissue encapsulation.
Purpose of the Study:
- To describe a case of recurrent severe MR due to SLDA after TEER.
- To highlight the surgical management strategy for late-phase SLDA.
- To discuss the implications for future TEER procedures and patient selection.
Main Methods:
- A case report of an 87-year-old male patient with recurrent MR post-TEER.
- Intraoperative findings including SLDA at the P1 leaflet and A1 chordal rupture.
- Surgical intervention involving en bloc resection of the MitraClip NT︎ and leaflet, chordal implantation, and annuloplasty.
Main Results:
- Successful elimination of regurgitation through complex surgical repair.
- Demonstration that en bloc resection is necessary for late-phase SLDA.
- Posterior leaflet SLDA is more amenable to repair than anterior leaflet SLDA.
Conclusions:
- En bloc resection of the device and leaflet is crucial for managing late-phase SLDA-related recurrent MR.
- Surgical approach must be individualized based on leaflet morphology and clip location.
- Minimizing operative and cardiopulmonary bypass times is critical for patients with limited surgical tolerance undergoing TEER revision.
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