BACKGROUND: Diffuse alveolar hemorrhage is rarely associated with acute mitral valve regurgitation. Emerging evidence of transcatheter edge-to-edge repair (TEER) use for treating acute mitral regurgitation has promoted TEER as a promising alternative to mitral valve surgery, owing to reduced mortality and complications.

CASE REPORT: A 66-year-old female patient with a history of thyroid nodules presented with dyspnea and hemoptysis. Imaging confirmed bilateral pleural effusions, with opacities suggestive of diffuse alveolar hemorrhage, and echocardiography revealed acute severe mitral valve regurgitation. The patient chose TEER over surgical valve replacement. After discharge on apixaban for new-onset atrial fibrillation, she returned a week later with melena and worsening dyspnea. Echocardiography demonstrated recurrent mitral valve regurgitation, and bronchoscopy confirmed diffuse alveolar hemorrhage. Despite aggressive management, the patient died.

CONCLUSIONS: This case highlights the complexity of managing acute severe mitral regurgitation complicated by diffuse alveolar hemorrhage in a patient requiring anticoagulation. Although a TEER procedure using the Pascal device was performed, the patient’s condition continued to deteriorate, underscoring the importance of individualized treatment strategies, as surgical mitral valve replacement may offer more definitive hemodynamic correction in selected cases.

Keywords: Cardiovascular Diseases, Dyspnea, Hemorrhage, Humans, Female, Aged, Mitral Valve Insufficiency, Fatal Outcome, Pulmonary Alveoli, Lung Diseases, Acute Disease, cardiac catheterization, Heart Valve Prosthesis Implantation