# Managing Commissural Mitral Valve Regurgitation Following Transcatheter Mitral Valve Repair Using the Amplatzer Occluder Device

## TL;DR

A 74-year-old man with recurring mitral valve regurgitation was successfully treated using an off-label device when other options were not viable.

## Contribution

A novel off-label use of the Amplatzer PFO Occluder device is proposed for managing recurrent commissural mitral regurgitation.

## Key findings

- The patient experienced severe recurrent MR after a MitraClip procedure.
- The Amplatzer device was successfully used to manage the MR in a high-risk patient.
- This case highlights a potential alternative treatment for patients unsuitable for repeat MitraClip or surgery.

## Abstract

Mitral regurgitation (MR) is a common valvular abnormality in patients in the Western world. Treatment options include surgery and edge-to-edge repair of the mitral valve leaflets using the MitraClip device. However, MR may recur, and MitraClip can be unsuccessful, posing a challenging management dilemma. We present a case involving a 74-year-old male patient who originally presented due to severe symptomatic MR. The patient originally underwent successful intervention with a MitraClip. However, the patient reported recurrent dyspnea with little effort approximately six months after the index procedure. A repeat 3D transesophageal echocardiogram revealed severe recurrent MR at the medial commissure with an eccentric jet, similar to findings from prior studies. Due to the medial location of the defect, limited space to steer an additional clip, and high surgical risk, the patient was not a suitable candidate for surgical intervention or repeat MitraClip (Abbott Vascular, Santa Clara, CA) placement. The severe recurrent commissural MR was successfully managed using an Amplatzer Patent Foramen Ovale Occluder device (St. Jude Medical, Minneapolis, MN) in an off-label fashion.