Severe Mitral Regurgitation in Mirror-Image Dextrocardia

Mirror-image dextrocardia with severe mitral regurgitation (MR) is a rare congenital anomaly that significantly increases the complexity of transcatheter mitral valve edge-to-edge repair (TEER). We report the case of a 72-year-old woman with mirror-image dextrocardia and severe MR who underwent successful TEER using the MitraClip system. Because of the anatomic reversal, several procedural adaptations were required, including modified transesophageal echocardiography views, adjustments to atrial septal puncture technique, and novel strategies for delivering the clip and resolving the "aortic hug." This case highlights the unique technical challenges of performing TEER in a patient with mirror-image dextrocardia. Specific procedural modifications were necessary for optimal catheter navigation and leaflet grasping. TEER in patients with mirror-image dextrocardia and severe MR requires specific adaptations. Successful outcomes require operators with substantial TEER experience and excellent 3-dimensional spatial reasoning.