TEER for SAM of the Mitral Valve and Flail Posterior Mitral Leaflet

Transcatheter edge-to-edge repair (TEER) is approved for patients with symptomatic severe mitral regurgitation (MR) who are deemed inoperable or at high surgical risk with life expectancy of more than 1 year, but has also been used off-label in patients with hypertrophic obstructive cardiomyopathy (HOCM) for symptomatic relief who are not candidates for septal reduction therapy. An 83-year-old woman with decompensated heart failure was found to have HOCM with systolic anterior motion of the mitral valve and a large P2 flail segment with ruptured cords. TEER was performed resulting in mild MR and resolution of the prior left ventricular outflow tract gradient. HOCM is not solely a septal disease and mitral valve pathology warrants addressing. This case represents successful utilization of TEER for severe MR and HOCM with systolic anterior motion of the mitral valve, treating both acute degenerative MR and left ventricular outflow tract obstruction. This case supports TEER for patients with medication-refractory HOCM who are not surgical candidates while highlighting that it can be done concomitantly for degenerative MR.