Yang Yuanting, Song Hongning, Zhou Qing, Xu Changwu, Zhang Ji, Zhu Da, Chen Jing
Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
JACC Case Rep. 2025 Mar 19;30(6 Pt 2):103527. doi: 10.1016/j.jaccas.2025.103527.
Mitral regurgitation (MR) secondary to leaflet perforation after transcatheter edge-to-edge repair (TEER) is a rare yet critical complication requiring careful evaluation and management.
A 75-year-old male with coronary artery disease underwent TEER for severe functional MR. Postprocedure, recurrent MR due to a large anterior leaflet perforation in the A2 region was observed. A three-dimensional (3D)-printed model revealed the perforation size was significantly larger than echocardiographic measurements, underscoring the necessity of precise device sizing for effective occlusion.
This case highlights the risk of leaflet perforation post-TEER, likely due to tension release during the procedure. Loss of leaflet insertion on echocardiography may indicate perforation. The use of 3D-printed models provided critical insights into perforation morphology, enhancing procedural planning and demonstrating the value of advanced imaging techniques in complex cases.
TAKE-HOME MESSAGE: This case emphasizes the importance of device oversizing for large perforations and the role of patient-specific 3D modeling in optimizing TEER outcomes, offering potential value for procedural planning and complication management.
经导管缘对缘修复术（TEER）后因瓣叶穿孔导致的二尖瓣反流（MR）是一种罕见但严重的并发症，需要仔细评估和处理。
一名75岁患有冠状动脉疾病的男性因严重功能性MR接受了TEER。术后，观察到由于A2区域的前叶大穿孔导致复发性MR。三维（3D）打印模型显示穿孔尺寸明显大于超声心动图测量值，强调了精确选择器械尺寸以实现有效封堵的必要性。
该病例突出了TEER后瓣叶穿孔的风险，可能是由于手术过程中的张力释放。超声心动图上瓣叶附着点的丧失可能提示穿孔。3D打印模型的使用为穿孔形态提供了关键见解，有助于手术规划，并证明了先进成像技术在复杂病例中的价值。
该病例强调了对于大穿孔选择尺寸更大的器械的重要性以及患者特异性3D建模在优化TEER结果中的作用，为手术规划和并发症管理提供了潜在价值。
