Unusual Suspect Causing Myocardial Infarction

Abstract

An 84-year-old man with New York Heart Association functional class III/IV, due to prolapse of segment 2 of the anterior mitral valve leaflet with severe regurgitation as a result, was admitted for elective percutaneous edge-to-edge mitral valve repair. Significant coronary artery disease was ruled out previously. The left ventricular systolic function was normal with moderate concomitant aortic regurgitation. Mitral valve surgery was not considered a suitable option by the heart team due to frailty and a prohibitive surgical risk profile. The patient had an indication for transcatheter mitral-leaflet approximation, using the MitraClip-NT device (Abbott Vascular, Abbott Park, IL, USA). Implantation of the first clip resulted in insufficient reduction of mitral regurgitation. Therefore, a second device was positioned. Within minutes after release, transesophageal ultrasonography showed single leaflet device attachment of the second device, necessitating the deployment of a third device in order to stabilize the flailing clip (Figure 1a). Although regurgitation was reduced to moderate hereafter, flailing of the second device persisted.