Acute Left Ventricular Dysfunction After Mitral Transcatheter Edge-to-Edge Repair.

BACKGROUND

Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for severe mitral regurgitation. However, acute left ventricular (LV) dysfunction may complicate the procedure through mechanisms with distinct implications.

CASE SUMMARY: An 81-year-old man with severe primary mitral regurgitation underwent elective M-TEER. Immediately after clip deployment, he developed acute LV dysfunction, initially managed as afterload mismatch (AM) with vasodilators. The clinical evolution was associated with apical ballooning on echocardiography, with electrocardiographic changes and troponin elevation without obstructive coronary disease, supporting Takotsubo syndrome (TTS). The patient remained stable, and LV function fully recovered within 1 week.

DISCUSSION: This case illustrates the difficulty of distinguishing AM from TTS after M-TEER, 2 entities with overlapping features but different prognostic and therapeutic implications.

TAKE-HOME MESSAGES: Acute LV dysfunction after M-TEER should not be automatically attributed to AM. TTS should be considered, and the integration of clinical, echocardiographic, and electrocardiographic findings is essential to management.