Severe Mitral regurgitation (MR) when complicated by a co-existing lung abscess, is a  management challenge, as both conventional cardiac and thoracic surgical interventions may be contraindicated. In the case described below transcatheter edge-to-edge mitral valve repair (TEER) was utilised to achieve haemodynamic stability permitting subsequent thoracic surgical lung abscess resection. 

We report the case of a 60-year-old male with torrential mitral regurgitation (MR) secondary to chordal rupture presenting with recurrent pulmonary oedema, complicated by lung sepsis and abscess formation resistant to antibiotic therapy and precluding open valvular repair. The presence of a lung abscess contraindicated open mitral valve repair and the severity of MR  precluded thoracic surgical treatment of the lung abscess precluding any form of surgical  intervention. 

 A successful TEER procedure resulted in a reduction of MR from severe to no more than mild to moderate enabling haemodynamic stabilisation and permitting subsequent thoracic surgical treatment of the lung abscess. 

Our case demonstrates the possibility of treating severe MR with TEER in the presence of a lung  sepsis and abscess, when both conventional cardiac and thoracic surgical interventions were considered contraindicated. This later enabled thoracic surgery and treatment of the lung abscess.

Farah Greiw is an Internal Medicine Trainee at the North London Deanery; she is currently completing a rotation in medical oncology at the Royal Marsden Hospital. Has extensive experience working at a health technology startup. She has a MSc in Prenatal genetics and Foetal medicine from UCL and is particularly interested in genetic cardiology.