Acute Type B Aortic Dissection Following Transcatheter Mitral Valve Edge-to-edge Repair: A Case Report

Transesophageal echocardiography is rarely reported as a possible cause of aortic dissection during the transcatheter edge-to-edge repair procedure. Herein, we present a case of type B aortic dissection following the transcatheter mitral valve edge-to-edge repair procedure, most likely related to the transesophageal echocardiography probe. A 68-year-old Chinese man complained of exertional dyspnea lasting over 2 years and had been diagnosed with severe mitral regurgitation. He was admitted to our hospital for the treatment of severe mitral regurgitation with transcatheter edge-to-edge repair. One MitraClip XTR(Abbott Vascular) was successfully implanted under the guidance of active transesophageal echocardiography and the mitral regurgitation became trace. However, the patient complained of persistent back pain after the treatment and computed tomography angiography revealed a type B aortic dissection in the descending aorta. After two weeks of unsuccessful conservative treatment, he successfully underwent endovascular stenting and was discharged from the hospital. The patient recovered well and remained event-free during the six-month follow-up. Herein, we presented a rare complication following transcatheter mitral valve edge-to-edge repair that was most likely related to the transesophageal echocardiography probe--type B aortic dissection. We postulated that repetitive flexion of the transesophageal echocardiography probe led to compression-induced injury to the descending aorta wall at the mid-esophageal level, which was the most probable etiology of type B aortic dissection. Although this complication is rare, it is potentially fatal and therefore needs attention.