fig2

Figure 2. The Procedure of Mitral Transcatheter Edge-to-Edge Repair. (A) A posterior-superior atrial septal puncture was performed at a height of 4.21 cm from the mitral annular plane; (B) The SW0609 clip was oriented perpendicular to the line of coaptation (approximately 11 o’clock to 5 o’clock position) under 3D TEE guidance; (C) Both leaflets were on the clip arms; (D) Complete resolution of the P3-C2 prolapse with no residual regurgitation in that region after the first clip and significant residual MR from the untreated A1 prolapse persisted; (E) The mean trans-mitral pressure gradient (TMPG) measured 3 mmHg after the first clip; (F) The SN0409 clip was re-oriented (1 o’clock to 7 o’clock) to align with the anterolateral commissure; (G) Both leaflets were captured; (H) Stable tissue bridges on 3D imaging after the second clip deployment; (I) Only trace residual lateral MR were existed after the second clip deployment; (J) The final TMPG was 4 mmHg after the procedure. The yellow arrow indicated the residual regurgitation flow after clip deployment. TEE: Transesophageal echocardiography; MR: mitral regurgitation.