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First-in-man report of residual "intra-clip" regurgitation between two MitraClips treated by AMPLATZER Vascular Plug II.

AIMS
We present here the first-in-man case report of a patient with a significant residual "intra-clip" jet treated by the implantation of an AMPLATZER Vascular Plug II.


METHODS AND RESULTS
A 64-year-old gentleman came to our attention for mitral regurgitation (MR) recurrence four years after transcatheter mitral repair with MitraClip. After the implantation of two further MitraClips, residual intra-clip MR was present, without room for a further clip. An AMPLATZER Vascular Plug II was successfully deployed between the two clips. Final echocardiography showed residual mild MR, without any sign of mitral stenosis.


CONCLUSIONS
This case demonstrates the feasibility of the implantation of an AMPLATZER Vascular Plug between two MitraClips to treat significant residual "intra-clip" MR, when the implantation of an adjunctive clip is not feasible. This approach may represent an effective therapeutic solution in case of a significant residual intra-clip jet.