An 88-year-old woman with severe mitral regurgitation (MR) was hospitalized with pulmonary edema. She had a history of coronary artery disease, acute on chronic renal failure, atrial fibrillation, and morbid obesity. Surgical mitral valve (MV) repair was not possible due to prohibitive risk. Transesophageal echocardiography (TEE) revealed severe, eccentric MR secondary to a flail P2 posterior leaflet (C). Transcatheter MV repair with MitraClip (Abbott Vascular, Santa Clara, CA) was performed under general anesthesia with TEE guidance. Transseptal puncture was performed in a superior-posterior position. A 4F multipurpose catheter was inserted in the right superior pulmonary vein for continuous pressure monitoring. A, The 24-Fr MitraClip steerable guide catheter was placed in the left atrium (LA). B, MitraClips were positioned under TEE guidance. D, The first clip was placed laterally, and resulted in improvement in MR, and a reduction of the LA v-wave from 50 mm Hg to 35 mm Hg; however, a medial jet of MR remained, consistent with the persistent elevation in the v-wave. E, A second clip was placed medially, and further reduction of the LA v-wave to 18 mm Hg occurred. The residual MR was only mild.
