An 87-year-old woman with multiple morbidities was referred for transcatheter treatment of symptomatic, severe mitral regurgitation (MR) with MitraClip (Abbott Vascular, Santa Clara, CA).
A and B, Left ventricular outflow tract view on transesophageal echocardiography (TEE) demonstrates fibroelastic deficiency of the mitral valve and severe MR (arrowheads). C and D, Commissural imaging shows a flail segment on the medial side of the mitral valve, in association with MR on color flow-imaging (arrowheads). E, For effective grasping of the mitral leaflets, the clip arms should be placed perpendicular to the coaptation plane of the valve. For medial jets, the arms therefore should be rotated counterclockwise, often ending up in the region of 11 and 5 o’clock on a clock face. F, Placement of the clip here leads to significant reduction in MR. G, TEE with 3-dimensional imaging shows a large single orifice of the mitral valve (asterisk). H, TEE with color-flow imaging shows the final result with elimination of the MR following clip release.
Ao, Ascending aorta; L, lateral; LA, left atrium; LV, left ventricle; M, medial; RA, right atrium; RV, right ventricle.