{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T00:43:42Z","timestamp":1794271422321,"version":"4.9.0"},"reference-count":6,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,27]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>We report a case of early postoperative anterior mitral leaflet tear following a third transcatheter edge-to-edge mitral valve repair (TEER) procedure in a patient with dilated cardiomyopathy and heart failure with reduced ejection fraction. The patient, who had previously undergone two TEER procedures, developed recurrent mitral regurgitation (MR) and subsequently underwent a third TEER. However, after the third TEER, the MR worsened on postoperative day 3. Due to haemodynamic instability, repeat transoesophageal echocardiography could not be performed. The patient died 7\u2009months later. Autopsy revealed a large anterior leaflet tear near the third clip site, with differential endothelialisation between the third and earlier clips. This case highlights the risk of early postoperative leaflet injury following multiple TEER procedures and underscores the importance of careful patient selection and procedural planning in complex heart failure cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-268405","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:05:34Z","timestamp":1762848334000},"page":"e268405","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Early postoperative anterior leaflet tear following third transcatheter edge-to-edge mitral valve repair confirmed by autopsy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7545-0186","authenticated-orcid":false,"given":"Takashi","family":"Morinaga","sequence":"first","affiliation":[{"name":"Cardiovascular, Saga University, Saga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Isotani","sequence":"additional","affiliation":[{"name":"Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Shirai","sequence":"additional","affiliation":[{"name":"Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2025111100052490000_18.11.e268405.1","doi-asserted-by":"crossref","unstructured":"Praz F , Borger MA , Lanz J , et al . 2025 ESC\/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2025. doi:10.1093\/eurheartj\/ehaf194","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"2025111100052490000_18.11.e268405.2","doi-asserted-by":"crossref","first-page":"e932","DOI":"10.4244\/EIJ-D-21-00012","article-title":"Incidence and standardised definitions of mitral valve leaflet adverse events after transcatheter mitral valve repair: the EXPAND study","volume":"17","author":"Asch","year":"2021","journal-title":"EuroIntervention"},{"key":"2025111100052490000_18.11.e268405.3","doi-asserted-by":"crossref","first-page":"832","DOI":"10.5603\/CJ.a2023.0029","article-title":"Complications following transcatheter edge-to-edge mitral valve repair: Personal experience and review of the literature","volume":"30","author":"Maj","year":"2023","journal-title":"Cardiol J"},{"key":"2025111100052490000_18.11.e268405.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0223472","article-title":"Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation - A finite element modeling study","volume":"14","author":"Zhang","year":"2019","journal-title":"PLoS One"},{"key":"2025111100052490000_18.11.e268405.5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jbiomech.2016.11.013","article-title":"In vitro and in silico approaches to quantify the effects of the Mitraclip\u00ae system on mitral valve function","volume":"50","author":"Sturla","year":"2017","journal-title":"J Biomech"},{"key":"2025111100052490000_18.11.e268405.6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1001\/jamasurg.2016.3360","article-title":"Association of Uneven MitraClip Application and Leaflet Stress in a Finite Element Model","volume":"152","author":"Morgan","year":"2017","journal-title":"JAMA Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268405","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:05:36Z","timestamp":1762848336000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":6,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,10]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bcr-2025-268405"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268405","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}