Late complete detachment and embolization of a Pascal device used for mitral repair

A 55-year-old woman, who had undergone mitral transcatheter edge-to-edge repair using a Pascal ACE device 8-month earlier on a background of modified Bentall's procedure, presented to the emergency department with pulmonary oedema. A transoesophageal echocardiogram revealed severe mitral regurgitation, detachment of the Pascal device and dislodgement within the aortic valve prosthesis. Following Heart Team review, the patient underwent emergency mitral valve replacement and removal of the Pascal device. This case highlights an extremely rare complication of mitral transcatheter edge-to-edge repair and the need for emergency surgery even in patients who have been previously considered high-risk for cardiac surgery. • The rate of device detachment in patients undergoing mTEER is low but may be higher in patients with chronic inflammatory disorders and in patients on long-term steroid and immunosuppressive therapy. • Rapid diagnosis using including transthoracic and transoesophageal therapy is critical. • Heart Team review and cardiac surgery in patients previously deemed high-risk may be the only definitive therapy.