Background
The patient presented with functional mitral regurgitation (FMR) following atrial septal defect (ASD) repair. The lesion was located in the mitral valve at zone 2, slightly extending to zone 3. Due to the history of ASD patching, the difficulty of atrial septal puncture was significantly increased.
Diagnostic Evaluation
- Heart failure
- Coronary artery disease
- Hypertension
- Type 2 diabetes mellitus
- Valvular heart disease with severe mitral valve regurgitation
- 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, but the height was insufficient. The "A" knob was adjusted 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 zone 2, successfully capturing and clamping the leaflet. 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 the ASD closure device in the conventional puncture pathway greatly limited 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.
