Transcatheter Mitral Valve Repair for a Patient with Double Inferior Vena Cava: Case Report

A transcatheter edge-to-edge repair (TEER) is disseminating gradually as a treatment for primary and secondary mitral regurgitation in patients with high surgical risk. In performing TEER, securing a safe access route is crucial. We report a case with a challenging access route due to the presence of a double Inferior Vena Cava (IVC) and the patient's small body habitus. An 84-year-old female presented with congestive heart failure due to severe mitral regurgitation (MR). Despite receiving optimal medical therapy, her symptoms did not improve significantly. TEER was deemed challenging due to her extremely small body habitus (Height: 131 cm, BSA: 1.17m2) and the presence of double IVC. However, considering her inoperable risk for surgical repair, she underwent TEER after a multidisciplinary heart team discussion. The steering guide catheter (SGC) encountered resistance, but gradual advancement and use of a bougie with a large bore sheath dilator successfully delivered the SGC to the right atrium. Following the TEER, there was a significant improvement in the symptoms. Extremely small venous system in a small patient with double IVC presented a unique technical hurdle. TEER is potentially feasible even in such a patient by cautiously applying the technique described.