{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T21:15:00Z","timestamp":1768252500805,"version":"3.49.0"},"reference-count":7,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T00:00:00Z","timestamp":1596153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32HL129948"],"award-info":[{"award-number":["T32HL129948"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>An 80\u2010year\u2010old male with severe, complex mitral regurgitation (MR) after recent transcatheter aortic valve replacement presented in heart failure for percutaneous mitral valve repair and possible tricuspid valve repair. Transesopheageal echocardiography (TEE) demonstrated mixed Carpentier Types 1 and 2 components with annular dilation, two leaflet perforations, and excessive leaflet motion (P2 flail). There were three distinct MR jets appreciated reflecting a central coaptation defect and two posterior mitral valve leaflet perforations emanating from a cystic dilatation. Under TEE guidance transseptal puncture and percutaneous edge\u2010to\u2010edge mitral valve repair was performed with a MitraClip XTR device (Abbott, IL). A 10\u2009mm Amplatzer Muscular VSD Occluder (Abbott, Abbott Park, IL) was deployed to close one of the perforations on the posterior leaflet with a significant reduction in MR severity. Attempts at crossing the remaining defect were unsuccessful and the procedure was concluded. The patient recovered uneventfully and transthoracic echocardiography on postoperative day (POD) 1 and again on POD 34 demonstrated normal systolic dominance on pulmonary venous Doppler interrogation, mild to moderate MR, and a mean transvalvular gradient of 5\u2009mmHg. Both devices appeared firmly attached and stable. This is the first documented use of a VSD occluder device in this clinical scenario. Management of complex MR with an approach combining edge\u2010to\u2010edge repair for a central coaptation defect and leaflet flail with codeployment of a VSD occluder device to address a perforated leaflet is feasible and can achieve durable results.<\/jats:p>","DOI":"10.1002\/ccd.29147","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T18:01:05Z","timestamp":1596218465000},"page":"1333-1338","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Codeployment of a percutaneous edge\u2010to\u2010edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3856-6419","authenticated-orcid":false,"given":"Dylan R.","family":"Addis","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Division of Molecular and Translational Biomedicine, and the UAB Comprehensive Cardiovascular Center University of Alabama at Birmingham School of Medicine  Birmingham Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology and Department of Medicine, Division of Cardiovascular Disease University of Alabama at Birmingham School of Medicine  Birmingham Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"von Mering","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Disease, and the UAB Comprehensive Cardiovascular Center University of Alabama at Birmingham School of Medicine  Birmingham Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Disease University of Alabama at Birmingham School of Medicine  Birmingham Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,31]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/apc.APC_162_18"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-8932(10)70121-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.12.004"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.11.043"},{"key":"e_1_2_7_6_1","first-page":"304","article-title":"Bail\u2010out use of the Amplatzer Septal Occluder for treatment of acute iatrogenic leaflet perforation during the MitraClip procedure in a patient with functional mitral regurgitation","volume":"14","author":"Klapyta A","year":"2018","journal-title":"Postep Kardiol Inter"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2019.10.014"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.09.038"}],"container-title":["Catheterization and Cardiovascular 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