A 78-year-old man with progressive dyspnea was referred for evaluation of mitral valve (MV) disease. The echocardiogram demonstrated a dilated left ventricle with severely reduced systolic function and severe functional mitral regurgitation (MR). MR remained severe despite maximal medical therapy. After evaluation by a cardiothoracic surgeon and a multidisciplinary heart team, he was considered to be a poor candidate for surgical MV intervention, and was referred for percutaneous transcatheter valve repair with the MitraClip system (Abbott Vascular, Santa Clara, CA). A and B (arrow, restricted chordae), Transesophageal echocardiogram (TEE) demonstrated restricted anterior and posterior mitral leaflets with severe central regurgitation. C, An initial grasp was performed on the medial aspect of the severe jet (medial A2:P2) with modest MR reduction. D, A second clip was then placed in the central portion of the jet, with distortion of the more lateral orifice zone of coaptation and significant worsening of the MR laterally. E, The central clip was released and moved laterally to the lateral edge of A2:P2, resulting in a more favorable coaptation zone with significant reduction in overall MR. The patient was discharged, and did well with a reduction in MR to 1+, and a mean diastolic MV gradient of 5 mm Hg at 30-day follow-up.
Ao, Ascending aorta; LA, left atrium; Lat, lateral; LV, left ventricle; Med, medial.