Background The patient presented with functional mitral regurgitation (FMR), with the lesion located in the 2nd zone of the mitral valve, extending towards the 3rd zone. Due to a history of atrial septal defect (ASD) repair, the difficulty of atrial septal puncture was increased.
Diagnosis and Examination
- Heart failure
- Coronary artery disease
- Hypertension
- Type 2 diabetes mellitus
- Mitral valve regurgitation (severe)
- Post-ASD closure
Surgical Procedure: Under the dual guidance of transesophageal echocardiography (TEE) and digital subtraction angiography (DSA), the puncture was performed at a lower and posterior position to avoid the ASD closure device. A single XTR clip was used for mitral valve repair. The puncture site was 3.1 cm from the mitral annular plane, which was insufficient in height. The "A" knob was used to gain additional height, and the "+" knob was used to eliminate Huge. By manipulating the "M" knob, the mitral clip was precisely positioned directly above the 2nd zone, successfully capturing and clamping the leaflets. TEE examination showed that the mitral regurgitation was significantly reduced to trace levels, and the pulmonary venous flow reversal was markedly improved.
Conclusion The presence of a previous ASD closure device in the conventional puncture pathway greatly limits the feasibility of mitral valve intervention. In this case, a precise puncture strategy successfully established a surgical pathway, providing a viable solution for patients who have undergone ASD closure.
