Abstract
BACKGROUND: Recurrent mitral regurgitation (MR) after transcatheter edge-to- edge repair with MitraClip (Abbott) poses clinical and technical challenges. CASE SUMMARY: An 84-year-old man with prior successful MitraClip repair presented with NYHA functional class III dyspnea 1 year later. Imaging showed severe recurrent MR due to progressive leaflet prolapse. Given his comorbidities and high surgical risk, a percutaneous option was chosen. An Amplatzer Valvular Plug III (Abbott) was implanted to treat the dominant jet. Additional MitraClip placement, initially considered, was aborted owing to rising transvalvular gradients. The final result indicated mild MR, hemodynamic improvement, and symptom resolution. DISCUSSION: This case illustrates the feasibility of a tailored, hybrid transcatheter approach in MitraClip failure using a vascular plug, with attention to hemodynamic impact to avoid iatrogenic stenosis. TAKE-HOME MESSAGE: A hybrid strategy, including plug closure, may offer a viable option for recurrent MR after MitraClip in selected patients.