MitraClip for Severe Mitral Regurgitation from Chordal Rupture during Balloon Aortic Valvuloplasty

Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement for high-, intermediate-, and low-risk patients. Paravalvular leak (PVL) is a complication of TAVR that can be effectively treated with balloon dilation and vascular plugs. We report a case of an 86-year-old male presenting with symptomatic severe aortic stenosis. After the index TAVR procedure, mild-to-moderate PVL was noted. Two years post-operation, the patient presented with symptomatic severe PVL, which was initially treated by balloon dilation with additional volume. During balloon dilation, the balloon slipped into the left ventricle and tore a chord, leading to new severe mitral regurgitation (MR) while the PVL remained unchanged. Subsequently, an Amplatzer vascular plug II (Abbott) was successfully used to reduce the PVL to mild, and a MitraClip NTR (Abbott) was used to successfully reduce the MR to trivial. Although balloon dilation can be an effective method for reducing PVL, mitral valve chordal rupture is a rare complication if the wire is entrapped in the chordae and the balloon slips into the ventricle.