Transcatheter Edge-to-Edge Repair of Mitral Valve Leaflet Perforation Guided by 3D Multiplanar Reconstruction Imaging

Mitral valve leaflet perforation is generally considered unsuitable anatomy for transcatheter edge-to-edge repair (TEER), with published experience largely limited to bailout treatment of iatrogenic perforations.

A 75-year-old man with severe symptomatic mitral regurgitation (MR) was referred for TEER. Intraprocedural transesophageal echocardiogram (TEE) unexpectedly revealed a large posterior mitral leaflet perforation. Guided by 3D multiplanar reconstruction imaging, 2 XTW MitraClip devices were deployed on both sides of the perforation, effectively "sandwiching" the defect between the clips and reducing MR from severe to mild.

This case supports the feasibility of MitraClip as a primary treatment for mitral leaflet perforation in carefully selected patients. TEE with 3D multiplanar reconstruction imaging enabled accurate anatomic characterization and facilitated precise device positioning, resulting in an excellent procedural outcome.

Mitral valve leaflet perforation may be amenable to TEER in select cases. 3D TEE imaging is critical for procedural planning and helps to facilitate precise device positioning.