A creative transcatheter approach to correct complex recurring mitral regurgitation after previous surgical repair.

Aims: Leaflet perforations are usually not treated by interventional therapy. In our case we describe a clinical scenario after previous surgical repair of mitral regurgitation combining several treatment strategies for correction.

Methods And Results: Under general anaesthesia, and using echocardiographic as well as fluoroscopic guidance, a transseptal approach was carried out and two MitraClips were implanted at the level of A2/P2. At completion echocardiography, a new large regurgitation jet was observed in the centre of the anterior mitral leaflet. We decided to proceed with the implantation of an 8 mm AMPLATZER ASD septal occluder device (AMPLATZER Septal Occluder; St. Jude Medical, St. Paul, MN, USA) to seal the defect. This was accomplished and final echo showed remaining trivial regurgitation from the coaptation area, while the perforation was completely sealed. The patient was discharged in a clinically improved condition. Pre-discharge transthoracic echocardiography showed the two MitraClips as well as the Amplatzer device in a stable correct position with trivial residual mitral regurgitation.

Conclusions: The harmonisation of two diametral techniques for the treatment of recurring mitral regurgitation was effective in correcting the underlying problem. This approach may serve as an addition to the armamentarium of physicians treating patients with structural heart valve defects.