Abstract
BACKGROUND: Mitral clip detachment with embolization is an exceedingly rare complication with an incidence rate of <0.1%. Our case report describes a patient with subacute MitraClip (Abbott) embolization into the noncoronary sinus (NCS). CASE SUMMARY: Our patient was an 84-year-old man with a history of heart failure with preserved ejection fraction and severe mitral regurgitation requiring transcatheter-edge-to-edge repair with 3 MitraClips 2 weeks before presentation. He presented with acute decompensated heart failure with an elevated pro-B-type natriuretic peptide value (5,883 pg/mL), a chest radiograph revealing a displaced clip, and a transthoracic echocardiogram confirming severe mitral regurgitation with a flail leaflet. Eventually, a transesophageal echocardiogram revealed embolization to the NCS. DISCUSSION: Using a heart team approach in addition to palliative care, we discussed surgical and nonsurgical options. Despite his high surgical risk, the patient preferred a surgical approach. The MitraClip was successfully retrieved, and a mitral bioprosthesis was implanted. TAKE-HOME MESSAGES: MitraClip embolization is rare, with limited understanding of risk factors and optimal management strategy. Risk factors may include suboptimal intraoperative images, technical challenges, and complex anatomy. Management requires a heart team approach with consideration for palliative care involvement.