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Surgery is the treatment of choice for patients with significant symptomatic mitral regurgitation (MR). However, up to 50% of them are denied the procedure due to high operative risk [1]. The MitraClip procedure has been recently widely adopted for the treatment of symptomatic patients with significant degenerative and functional mitral regurgitation who are deemed inoperable [2]. Percutaneous edge-to-edge repair is an efficient technique for the majority of patients with significant MR. Nevertheless, there are still cases with residual significant mitral regurgitation after the device deployment, which cannot be fixed with additional clip implantation (i.e. significant jets in the commissural areas). Recently, a novel procedure was reported using the Amplatzer Duct Occluder II or Amplatzer Vascular Plug for residual MR after MitraClip implantation [3, 4]. Kubo et al. presented 9 patients treated electively for residual jets localized either between previously implanted clips or in the commissural areas [3]. In the main, the MitraClip procedure is safe with a 30day mortality rate up to 3% and a relatively small number of serious complications. Even so, in some cases it may occur and the operators should be able to fix them. The treatment of acute iatrogenic leaflet perforation with the implantation of an Amplatzer septal occluder (ASO) during a complicated MitraClip procedure is presented in the current report.

postępy w kardiologii interwencyjnej

Bail-out use of the Amplatzer Septal Occluder for treatment of acute iatrogenic leaflet perforation during the MitraClip procedure in a patient with functional mitral regurgitation