A Challenging Redo Mitral Clip Procedure in a Complex Clinical Scenario

Background: Transcatheter edge-to-edge repair (TEER) is pivotal for high-risk, severe mitral regurgitation. Redo TEER remains challenging, particularly with prior structural interventions such as atrial septal defect (ASD) closure complicating access and maneuverability. Case Summary: A 60-year-old man with severe functional mitral regurgitation and nonischemic dilated cardiomyopathy underwent redo TEER following clinical deterioration after a previous procedure. A previously implanted ASD occluder posed a significant anatomical challenge, however trans-septal puncture was successfully achieved adjacent to the ASD occluder without traversing or damaging it. The novel access approach allowed completion of the procedure without complications. Discussion: This case highlights the feasibility of redo TEER in patients with prior ASD occluder and underscores the critical importance of careful preprocedural planning, precise trans-septal puncture, and meticulous device handling to optimize procedural success. Take-Home Message: Redo TEER with prior ASD occluder is feasible with advanced imaging, planning, and multidisciplinary collaboration.