Transapical Mitral Valve Implantation After Closure of Posterior Mitral Annulus Cavity With a Nitinol Occluder

Mitral valve infective endocarditis involves a mitral annular abscess in approximately 15% of cases, and surgery is the treatment of choice for this scenario. An 80-year-old comorbid man with eradicated infective endocarditis had an emptied abscess cavity of the posterior mitral valve annulus (with left ventricular-left atrial connections) and had severe paravalvular and coexistent relevant transvalvular mitral regurgitation. He was not a surgical candidate. Successful management was with cavity closure, using a Nitinol occluder device, and transcatheter mitral valve implantation. This case demonstrates a novel transcatheter management approach to treat coexistent postendocarditis paravalvular and relevant transvalvular mitral regurgitation in a patient whose surgical risk was prohibitively high because of comorbidities.