Late complete detachment and embolization of a Pascal device used for mitral repair

A 55-year-old woman, who had undergone mitral transcatheter edge-to-edge repair using a Pascal ACE device 8-month earlier on a background of modified Bentall's procedure, presented to the emergency department with pulmonary oedema. A transoesophageal echocardiogram revealed severe mitral regurgitation, detachment of the Pascal device and dislodgement within the aortic valve prosthesis. Following Heart Team review, the patient underwent emergency mitral valve replacement and removal of the Pascal device. This case highlights an extremely rare complication of mitral transcatheter edge-to-edge repair and the need for emergency surgery even in patients who have been previously considered high-risk for cardiac surgery.