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Published on: December 23, 2022
Vascular Plug Closure of Delayed Leaflet Perforation Post-TEER in Patient With Multiple Implantable Devices
Guanzhong Chen1, Zhenyu Xiong1, Menghui Liu1
1Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, China.
Background:
Transcatheter edge-to-edge repair (TEER) is the main minimally invasive therapy for severe mitral regurgitation (MR) in patients at high surgical risk. Roughly 10% of patients develop recurrent MR within 1 year postoperatively. Postprocedural mitral anatomical distortion complicates reintervention, rendering recurrent MR management a common clinical challenge.
Case Summary:
A 63-year-old man with multivalvular heart disease, chronic heart failure, multiple implantable devices and dialysis-dependent end-stage renal disease presented with symptomatic severe recurrent MR secondary to delayed anterior mitral leaflet perforation after TEER. Under combined fluoroscopic and 3-dimensional transesophageal echocardiographic guidance, our multidisciplinary team performed transcatheter closure of the perforation using a vascular plug. MR was markedly alleviated, heart failure symptoms resolved, and the patient recovered uneventfully before discharge.
Discussion:
TEER-related leaflet perforation caused severe recurrent MR. Percutaneous plug closure successfully downgraded MR to trivial, confirming the feasibility of this approach for mitral leaflet perforation.
