In patients with severe primary mitral regurgitation due to chordal rupture, surgical repair is the treatment of choice. Transcatheter mitral chordal devices enable less invasive repair, providing promising initial results. However, their use  in the acute setting is limited because of the required preprocedural  planning. The MitraClip represents another therapeutic option, especially in inoperable patients with relevant mitral regurgitation. There are few data on its use in acute valve regurgitation secondary to ischaemic tendon rupture.

This makes this clinical case special.

In this case report, we present a 54-year-old patient who was admitted to our hospital after successful resuscitation for ventricular fibrillation. He was haemodynamically severely impaired, no ST elevations were evident in the ECG. Coronary angiography revealed a severe coronary 3-vessel disease with chronic occlusions of the right coronary  and the circumflex artery and high-grade stenosis of the left anterior descending. There was no obvious culprit lesion. Echocardiography showed a severe reduced left ventricular function and a large pericardial effusion without evidence of wall rupture. The predominant finding was a severe mitral regurgitation due to chordal rupture. After an emergency interdisciplinary colloquium, the mitral valve was immediately treated with a MitraClip device. After haemodynmic stabilisation, the coronary stenoses were treated under Impella protection in a further intervention.

At the 6-month follow-up, the patient was symptom-free and the coronay status was stable. Echocardiographically, only a mildly impaired left ventricular function and a mild mitral valve regurgitation was detected.

This case represents a therapeutic alternative to a surgical treatment in the acute setting.