TEER Beyond Contraindication: Resolving Recurrent Cerebral Infarction in a Patient With Degenerative Mitral Regurgitation

BACKGROUND: Degenerative mitral regurgitation (MR) is a common valvular heart disease, with transcatheter edge-to-edge repair (TEER) an alternative option for high-risk patients. Non-bacterial thrombotic endocarditis (NBTE), a rare condition with sterile valvular excrescences, often causes cerebrovascular embolism and is thought to be the contraindication to TEER. CASE SUMMARY: A 52-year-old man with multiple comorbidities presented to the hospital with recurrent cerebral infarctions, massive MR and NBTE. TEER and carotid embolic protection device implantation were performed to ameliorate MR, avoid the recurrence of cerebral embolism and delay the time for surgical valve replacement. DISCUSSION: The patient's history of ANCA-associated vasculitis, nephritis and glucocorticoid use made surgical treatment risky. TEER is feasible for severe degenerative MR with NBTE, especially with carotid protection, which reduces embolism risk and postpones valve replacement. TAKE-HOME MESSAGE: This case demonstrates the feasibility of TEER with concurrent NBTE and recurrent cerebral infarction when paired with carotid embolic protection.