An 83-year-old man with severe degenerative mitral regurgitation (MR) and multiple morbidities is referred for transcatheter repair with MitraClip (Abbott Vascular, Santa Clara, CA).
A, Baseline transesophageal echocardiogram showing severe MR on color-flow imaging (arrowhead). B, A clip is placed at the site of the MR with proper leaflet insertion. C, Following initial placement (arrow), there continues to be significant MR with regurgitation occurring on both sides of the clip. D, The clip is moved medially (arrowhead), leaving adequate room for a second clip in the A2-P2 segments of the mitral valve (MV) to treat the residual regurgitation. E, A second clip is placed (arrow) lateral to the first one (arrowhead). F, Mild residual MR is present following placement of two clips.
Ao, Ascending aorta; L, lateral; LA, left atrium; LV, left ventricle; M, medial.