Unintentional sealing of the mitral valve with a second MitraClip. “Once bitten, twice shy”

A 70-year-old woman with known complete thoracic paraplegia, chronic obstructive pulmonary disease and gastrointestinal bleedings was referred for a MitraClip® (Abbott Vascular, Santa Clara, CA, USA) procedure for symptomatic mitral regurgitation (MR). Echocardiography showed moderate-severe MR due to prolapse of degenerated leaflets (Barlow’s disease) (Online Figure 1, Online Figure 2, Moving image 1, Moving image 2).

The first clip was implanted on the origin of the largest MR jet in a lateral position, reducing MR to moderate with a mean gradient of 3-4 mmHg. During closure of the second clip, complete sealing of the mitral valve (MV) occurred with concomitant loss of ...