A 66-year-old man was admitted to hospital for a planned percutaneous transcatheter mitral valve repair (Mitraclip) for severe mitral regurgitation after a previous mitral repair with an annuloplasty ring. He presented with increasing exertional dyspnoea and had clinical left heart failure on admission. His history was of ischaemic heart disease with stenting of the circumflex artery and posterolateral branch in 2001 and a vein graft to the first diagonal at the time of mitral valve repair for severe ischaemic mitral regurgitation in 2006. He had an implanted defibrillator.

Three dimensional transoesophageal echocardiography identified new dehiscence of the medial side of mitral annuloplasty ring with severe mitral regurgitation originating at the valve level.


The percutaneous valve repair was cancelled. He was treated with intravenous diuresis and Levosimendan. Dobutamine stress echocardiography...

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