JACC. Case reports · 2026
Combining Transcatheter Edge-to-Edge Repair and Commissural Plug Occlusion for Complex Degenerative Mitral Regurgitation.
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Li Yan-Jie, Ma Lan, Hao Zi-Yong, Pan Xin
Аннотация
BACKGROUND: Degenerative mitral regurgitation involving the commissures remains a challenging anatomical subset for transcatheter repair.
CASE SUMMARY: An 86-year-old male with high surgical risk presented with symptomatic, severe degenerative mitral regurgitation due to A3 prolapse extending to the posteromedial commissure and a measured mitral valve area of 3.8 cm2. The heart team was elected for transcatheter edge-to-edge repair. Despite successful implantation of a single clip in the A3-P3 region, moderate residual commissural regurgitation persisted. The small native valve area and insufficient leaflet length after the first clip precluded safe placement of a second device. As a bailout strategy, a vascular plug was deployed to specifically occlude the residual commissural leak.
DISCUSSION: This simultaneous hybrid approach successfully reduced mitral regurgitation to mild, demonstrating a novel solution for managing complex anatomical challenges where conventional transcatheter edge-to-edge repair is insufficient.
TAKE-HOME MESSAGES: Commissural involvement combined with a small mitral valve area and limited leaflet length may render conventional multiclip transcatheter edge-to-edge repair unfeasible, increasing the risk of residual regurgitation. This hybrid transcatheter strategy, combining edge-to-edge repair with targeted plug occlusion, can expand the treatable spectrum of complex degenerative mitral regurgitation in high-surgical-risk patients.
CASE SUMMARY: An 86-year-old male with high surgical risk presented with symptomatic, severe degenerative mitral regurgitation due to A3 prolapse extending to the posteromedial commissure and a measured mitral valve area of 3.8 cm2. The heart team was elected for transcatheter edge-to-edge repair. Despite successful implantation of a single clip in the A3-P3 region, moderate residual commissural regurgitation persisted. The small native valve area and insufficient leaflet length after the first clip precluded safe placement of a second device. As a bailout strategy, a vascular plug was deployed to specifically occlude the residual commissural leak.
DISCUSSION: This simultaneous hybrid approach successfully reduced mitral regurgitation to mild, demonstrating a novel solution for managing complex anatomical challenges where conventional transcatheter edge-to-edge repair is insufficient.
TAKE-HOME MESSAGES: Commissural involvement combined with a small mitral valve area and limited leaflet length may render conventional multiclip transcatheter edge-to-edge repair unfeasible, increasing the risk of residual regurgitation. This hybrid transcatheter strategy, combining edge-to-edge repair with targeted plug occlusion, can expand the treatable spectrum of complex degenerative mitral regurgitation in high-surgical-risk patients.