Single Leaflet Device Attachment with Hemolytic Anemia after Transcatheter Edge-to-Edge Mitral Valve Repair

Hemolytic anemia due to single leaflet device attachment (SLDA) is a rare but potentially fatal complication; to our knowledge, only a few cases with poor/unknown outcomes have been reported. 1,2) An 82-year-old male was referred to our hospital for elective transcatheter edge-to-edge mitral valve repair.Pre-procedural transesophageal echocardiography (TEE) showed severe mitral regurgitation deviating from the A2/ P2 region with functionally limited motion of the posterior leaflet, suggesting pseudo-prolapse.The P2 length and flail gap were 10.3 and 2.3 mm, respectively.There was no evidence of valve annular dilation or calcification.Based on the findings above, the procedure was performed with a MitraClip NT System (Abbott, Abbott Park, IL, USA) on the A2/P2 (Fig. 1A and Supplementary Movie 1).However, on postoperative day 4, the patient developed hemolytic anemia with elevated lactate