Transcatheter Repair of Anterior Mitral Leaflet Perforation in a Patient with Mechanical Aortic Valve Using Antegrade and Retrograde Approaches: Case Report

Abstract

Mitral leaflet perforations after surgical aortic valve replacement may be iatrogenic or due to endocarditis. We present a 20-year-old female who underwent surgical mechanical aortic valve replacement 8 months prior to this presentation for bicuspid severe aortic valve stenosis. She presented with acute decompensated heart failure with dyspnea and New York Heart Association (NYHA) functional class of III-IV. Transthoracic (TTE) and transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) through an anterior mitral leaflet perforation. The patient refused surgical repair and percutaneous closure of the perforation was decided and performed using both antegrade and retrograde approaches. In this report, we emphasize the details and challenges of the procedure.

Percutaneous closure of iatrogenic anterior mitral leaflet perforation: a case report

“… 1 , 4–7 Abuelatta et al . 1 reported a 2-year follow-up for a 20-year-old patient with iatrogenic AML perforation at A2 after a mechanical aortic valve replacement. The follow-up was good with no MR, and the AML tolerated the weight of an ASD 4-mm device nicely.…”

“…Percutaneous closure of AML perforation was performed successfully in our centre before. 1 After explaining the surgical and percutaneous options to the patient, highlighting that there is no evidence for long-term outcome for transcatheter option, he again selected not to have surgery. The team decided to do transcatheter closure of AML perforation.…”

“…Anterior mitral leaflet (AML) perforation leading to severe mitral regurgitation (MR) post-open-heart surgery may be iatrogenic. 1 Anterior mitral leaflet perforation may be the result of infective endocarditis at the aortic valve. 2 The usual treatment of severe MR due to AML perforation is surgical repair of the mitral valve (MV).…”

“… 3 Very few cases have been reported for percutaneous repair of perforated AML. 1 , 4–7 Percutaneous closure of AML perforation is not guideline based and there is insufficient evidence of success, it should be reserved for high-risk surgical patients. However, patient preference and local experience in structural heart disease intervention are factors that may contribute in selecting this procedure.…”

Transcatheter Mitral Valve Repair Technique in Specific Severe Mitral Regurgitation: Tips, Tricks, and Outcomes

“…MVL perforations have been reported to be iatrogenic in patients following cardiac surgeries such as MV repair, aortic valve (AV) surgeries, or congenital heart disease operations [2][3][4] and in patients who experienced transcatheter AV replacement. 5 Also, infective endocarditis or autoimmune diseases were considered causes of MVL perforations.…”