{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:10Z","timestamp":1787028910518,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Pre-procedure mitral regurgitation (MR) is a frequent coexistent finding in patients undergoing transcatheter aortic valve replacement (TAVR), and most of them (up to 55%) experience a significant improvement in MR after the procedure. Although seldom described, mitral valve perforation after TAVR is a potentially serious complication that physicians should be aware of, as moderate or severe MR in TAVR recipients is associated with a high early mortality rate. We herein describe the case of a 65-year-old man presenting with worsening heart failure symptoms 5 months after TAVR due to an intraprocedural anterior mitral leaflet perforation and discuss the diagnostic process and therapeutic course of the case. Furthermore, we draw attention to the essential role of echocardiography in the management of TAVR procedures, taking into account its ability in detecting early complications, and emphasize the value of CT as a main determinant to predict long-term MR improvement after TAVR and to assess the potential candidates for double valve repair with percutaneous techniques.<\/jats:p>","DOI":"10.3390\/medicina58040464","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T22:08:06Z","timestamp":1648073286000},"page":"464","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Rare Cause of Severe Mitral Regurgitation after TAVI: Case Report and Literature Review"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2241-279X","authenticated-orcid":false,"given":"Hora\u021biu","family":"Moldovan","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan-\u015etefan","family":"Popescu","sequence":"additional","affiliation":[{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Nechifor","sequence":"additional","affiliation":[{"name":"Sanador Clinical Hospital, 011038 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Badea","sequence":"additional","affiliation":[{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Ciomaga","sequence":"additional","affiliation":[{"name":"Sanador Clinical Hospital, 011038 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Nica","sequence":"additional","affiliation":[{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondin","family":"Zaharia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"\u201dProf. Dr. Theodor Burghele\u201d Clinical Hospital, 061344 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3660-8926","authenticated-orcid":false,"given":"Daniela","family":"Gheorghi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Broasc\u0103","sequence":"additional","affiliation":[{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6837-260X","authenticated-orcid":false,"given":"Camelia","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina","family":"Parasca","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. C.C. Iliescu\u201d Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"\u201cProf. Dr. C.C. Iliescu\u201d Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad Anton","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"\u201cProf. Dr. C.C. Iliescu\u201d Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jsha.2014.05.002","article-title":"The change in mitral regurgitation severity after trans-catheter aortic valve implantation","volume":"27","author":"Almasood","year":"2014","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.jacc.2012.02.020","article-title":"Transcatheter aortic valve replacement: Outcomes of patients with moderate or severe mitral regurgitation","volume":"59","author":"Toggweiler","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.jjcc.2016.02.001","article-title":"Prognostic impact and change of concomitant mitral regurgitation after surgical or transcatheter aortic valve replacement for aortic stenosis","volume":"67","author":"Fojt","year":"2016","journal-title":"J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1136\/heartjnl-2015-308842","article-title":"Mitral and aortic regurgitation following transcatheter aortic valve replacement","volume":"102","author":"Hryniewiecki","year":"2016","journal-title":"Heart"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jtcvs.2008.02.038","article-title":"Clinical outcomes of combined aortic root replacement with mitral valve surgery","volume":"136","author":"David","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"I443","DOI":"10.1161\/CIRCULATIONAHA.104.526046","article-title":"Aortic valve replacement and concomitant mitral valve regurgitation in the elderly: Impact on survival and functional outcome","volume":"112","author":"Barreiro","year":"2005","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"I541","DOI":"10.1161\/CIRCULATIONAHA.105.000976","article-title":"Natural History and Predictors of Outcome in Patients With Concomitant Functional Mitral Regurgitation at the Time of Aortic Valve Replacement","volume":"114","author":"Ruel","year":"2006","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1136\/heartjnl-2014-305775","article-title":"Impact of preprocedural mitral regurgitation upon mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis","volume":"100","author":"Khawaja","year":"2014","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Moldovan, H., Popescu, D., Buliga, T., Filip, A., Antoniac, I., Gheorghi\u0163\u0103, D., and Molnar, A. (2019). Gastric Adenocarcinoma Associated with Acute Endocarditis of the Aortic Valve and Coronary Artery Disease in a 61-Year-Old Male with Multiple Comorbidities\u2014Combined Surgical Management\u2014Case Report. Medicina, 55.","DOI":"10.3390\/medicina55060242"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1161\/CIRCULATIONAHA.107.698258","article-title":"Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis","volume":"116","author":"Webb","year":"2007","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1161\/CIRCULATIONAHA.110.948877","article-title":"Transcatheter aortic valve implantation: Durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort","volume":"122","author":"Gurvitch","year":"2010","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1056\/NEJMoa1008232","article-title":"Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery","volume":"363","author":"Leon","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1161\/CIRCULATIONAHA.109.929893","article-title":"Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction","volume":"122","author":"Clavel","year":"2010","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1161\/CIRCULATIONAHA.108.837807","article-title":"Transcatheter Aortic Valve Implantation: Impact on Clinical and Valve-Related Outcomes","volume":"119","author":"Webb","year":"2009","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.ejcts.2008.12.041","article-title":"Results of percutaneous and transapical transcatheter aortic valve implantation performed by a surgical team","volume":"35","author":"Bleiziffer","year":"2009","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","first-page":"149","article-title":"Aortic Prosthesis-Patient Mismatch Strongly Affects Early Results of Double Valve Replacement","volume":"23","author":"Iosifescu","year":"2014","journal-title":"J. Heart Valve Dis."},{"key":"ref_17","first-page":"307","article-title":"Transcatheter aortic valve implantation (TAVI) outcome according to standardized endpoint definitions by the Valve Academic Research Consortium (VARC)","volume":"23","author":"Felix","year":"2011","journal-title":"J. Invasive Cardiol."},{"key":"ref_18","first-page":"191","article-title":"Aortic valve surgery of the 21st century: Sutureless AVR versus TAVI","volume":"66","author":"Costache","year":"2018","journal-title":"Minerva Cardioangiol."},{"key":"ref_19","first-page":"15","article-title":"Transcatheter aortic valve implantation: Current and future approaches","volume":"9","year":"2011","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2926","DOI":"10.21037\/jtd.2020.01.69","article-title":"Mitral regurgitation after transcatheter aortic valve replacement","volume":"12","author":"Nappi","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4103\/jcecho.jcecho_52_19","article-title":"Anterior mitral leaflet perforation and infective endocarditis following transcatheter aortic valve replacement in a patient presenting with heart failure","volume":"30","author":"Sanna","year":"2020","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e233","DOI":"10.1016\/j.jcin.2016.10.009","article-title":"Perforation of Anterior Mitral Leaflet Due to Mechanical Stimulation Late After Transcatheter Aortic Valve Replacement","volume":"9","author":"Miura","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.jcin.2017.06.039","article-title":"Percutaneous Management of Mitral Perforation During Transcatheter Aortic Valve Replacement","volume":"10","author":"Bourezg","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1093\/eurheartj\/eht503","article-title":"Corevalve prosthesis causes anterior mitral leaflet perforation resulting in severe mitral regurgitation and subsequent endocarditis","volume":"35","author":"Raschpichler","year":"2013","journal-title":"Eur. Hear. J."},{"key":"ref_25","first-page":"87","article-title":"Infective endocarditis: Cause or consequence of delayed anterior mitral leaflet perforation after transcatheter aortic valve implantation?","volume":"69","author":"Revilla","year":"2016","journal-title":"Rev. Esp. Cardiol. Engl. Ed."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1002\/ccd.26410","article-title":"Delayed left anterior mitral leaflet perforation and infective endocarditis after transapical aortic valve implantation-Case report and systematic review","volume":"89","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E415","DOI":"10.1161\/CIRCULATIONAHA.109.879700","article-title":"Primary cardiac leiomyosarcoma when valvular disease becomes a vascular surgical emergency","volume":"121","author":"Jurcut","year":"2010","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jcin.2009.07.005","article-title":"Transcatheter Aortic Valve Implantation: Review of the Nature, Management, and Avoidance of Procedural Complications","volume":"2","author":"Masson","year":"2009","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e215","DOI":"10.1016\/j.jcin.2015.06.027","article-title":"Anterior Mitral Leaflet Perforation During Transcatheter Aortic Valve Replacement in a Patient With Mitral Annular Calcification","volume":"8","author":"Saji","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1016\/j.jacc.2012.05.061","article-title":"Acute Mitral Stenosis After Transcatheter Aortic Valve Implantation","volume":"60","author":"Franco","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40792-018-0446-z","article-title":"Acute torrential mitral regurgitation during transcatheter aortic valve replacement: A case report","volume":"4","author":"Yamashita","year":"2018","journal-title":"Surg. Case Rep."},{"key":"ref_32","first-page":"603","article-title":"Mitral regurgitation during transcatheter aortic valve implantation: The same complication with a different mechanism","volume":"26","year":"2014","journal-title":"J. Invasive Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.jcin.2016.05.025","article-title":"Mitral Regurgitation After Transcatheter Aortic Valve Replacement: Prognosis, Imaging Predictors, and Potential Management","volume":"9","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1016\/S0140-6736(15)60290-2","article-title":"5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): A randomised controlled trial","volume":"385","author":"Kapadia","year":"2015","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1016\/S0140-6736(15)60308-7","article-title":"5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial","volume":"385","author":"Mack","year":"2015","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1056\/NEJMoa1400590","article-title":"Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis","volume":"370","author":"Adams","year":"2014","journal-title":"N. Engl. J. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/4\/464\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:41:24Z","timestamp":1760136084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/4\/464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["medicina58040464"],"URL":"https:\/\/doi.org\/10.3390\/medicina58040464","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,23]]}}}