Successful Transcatheter Mitral Valve Repair for Iatrogenic Chordal Rupture in Cardiac Amyloidosis

Daisuke Kanda; Yoshihisa Horizoe; Akari Tajima; Hiroyuki Tabata; Youta Uchiyama; Mitsuru Ohishi

doi:10.1016/j.jaccas.2025.106137

Successful Transcatheter Mitral Valve Repair for Iatrogenic Chordal Rupture in Cardiac Amyloidosis

JACC Case Rep. 2026 Jan 14;31(2):106137. doi: 10.1016/j.jaccas.2025.106137. Epub 2025 Nov 21.

Authors

Daisuke Kanda¹, Yoshihisa Horizoe², Akari Tajima², Hiroyuki Tabata², Youta Uchiyama², Mitsuru Ohishi²

Affiliations

¹ Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. Electronic address: kanchan@m3.kufm.kagoshima-u.ac.jp.
² Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.

PMID: 41269195
DOI: 10.1016/j.jaccas.2025.106137

Abstract

Background: Cardiac amyloidosis is associated with poor prognosis. Biopsy-induced severe mitral regurgitation (MR) secondary to chordal rupture is a rare but critical complication, and its optimal management remains uncertain.

Case summary: A 78-year-old man with transthyretin cardiac amyloidosis developed acute severe MR after left ventricular myocardial biopsy, which caused rupture of the chordae tendineae. He presented with NYHA functional class IV heart failure. Given his condition, transcatheter edge-to-edge mitral valve repair (M-TEER) was prioritized. A MitraClip was successfully deployed, reducing the severe MR to mild without complications, and his symptoms markedly improved.

Discussion: This is to our knowledge the first reported case of biopsy-induced MR in cardiac amyloidosis successfully managed using M-TEER. This case demonstrates the safety and efficacy of M-TEER in frail patients with iatrogenic mechanical complications.

Take-home message: M-TEER may be a life-saving therapy for severe iatrogenic MR in patients with advanced cardiac amyloidosis.

Keywords: MitraClip; cardiac amyloidosis; chordae tendineae rupture; left ventricular endomyocardial biopsy; mitral regurgitation; structural heart intervention.

Publication types

Case Reports