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Updated: Jul 6, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter Edge-to-Edge Repair of a Functionally Trileaflet Mitral Valve
Toheed-Fatima Ali1, Hafez Golzarian2, Mallory Knous3
1Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.
Background:
A trileaflet configuration of the mitral valve is an uncommon anatomical finding that presents unique challenges for transcatheter repair.
Case Summary:
A 67-year-old man with a history of atrioventricular canal defect and prior mitral valve repair presented with symptomatic severe mitral valve insufficiency due to impaired leaflet coaptation from a cleft dividing the A2 scallop, creating a functionally trileaflet mitral valve. Given elevated surgical risk and patient preference to avoid reoperation, transcatheter edge-to-edge repair with the 2 PASCAL ACE system devices (Edwards Lifesciences) was successfully performed allowing restoration of coaptation and reduced mitral insufficiency to trace severity with a final transmitral mean gradient of 3 mm Hg.
Discussion:
This case highlights the adaptability of transcatheter edge-to-edge repair in unconventional mitral valve anatomy.
Take-Home Message:
Complex trileaflet or cleft mitral valves should not preclude transcatheter repair when guided by appropriate imaging and device strategy.
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