# Successful transcatheter edge-to-edge repair for atrial functional mitral regurgitation after surgical annuloplasty ring dehiscence: a case report

## TL;DR

A patient with severe mitral regurgitation after a failed surgical repair was successfully treated with a minimally invasive transcatheter procedure.

## Contribution

Demonstrates the feasibility and safety of TEER in patients with annuloplasty ring dehiscence.

## Key findings

- Transcatheter edge-to-edge repair using the G4-MitraClip® system was successful in treating severe AFMR after ARD.
- Meticulous pre-operative transoesophageal echocardiography simulation is crucial for successful TEER outcomes.
- The procedure avoided interference with the dislodged annuloplasty ring by targeting the medial A2–P2 region.

## Abstract

Annuloplasty ring dehiscence (ARD) after surgical mitral valve repair is a rare complication, which causes recurrent mitral regurgitation (MR) and is associated with adverse outcomes in patients with a prohibitive risk of repeat surgery. However, a patient developed severe MR, when challenging transcatheter edge-to-edge repair (TEER) after surgical ring dehiscence, it should be considering the relative efficacy and safety.

An 89-year-old man underwent mitral valve repair with an annuloplasty ring for moderate atrial functional MR (AFMR). Post-operative transthoracic echocardiography on Day 7 suggested a dislodged mitral annuloplasty ring and recurrent moderate AFMR. However, the MR developed severely, which led to two hospitalizations for congestive heart failure in the past year. Transoesophageal echocardiography (TOE) was performed carefully to ensure that the TEER clip did not interfere with the dislodged annuloplasty ring. Consequently, only the therapeutic target on the medial side of the A2–P2 region was approached posteriorly behind the peri-ring space, without gripper interference.

Transcatheter edge-to-edge repair using the G4-MitraClip® system is feasible and safe in patients with recurrent severe AFMR after surgical mitral valve repair concomitant with ARD. Meticulous simulation with pre-operative TOE is one of the crucial steps for successful outcomes.