Figure 5

MitraClip and Echocardiography Guidance of Positioning of MitraClip System. The clip is a wide cobalt/chromium implant with 2 arms (Panel A). TEE views used to guide transeptal puncture are bicaval view (Panel B), for inferior-superior orientation, basal short-axis view (30°-60°) (Panel C) for anterior-posterior orientation and midesophageal 4-chamber view (Panel D), for assessing height above the valve plane. The clip is moved to center the origin of the MR jet and axially aligned, by the midesophageal intercommissural view or "2 chambers" (60°) (Panel E), and the midesophageal long-axis LV outflow tract view (120-150°) (Panel F). Transgastric short-axis view at the mitral leaflet and subvalvular level (Panel G) is used to rotate the clip to achieve a perpendicular position with the line of coaptation at the middle scallops of the valve at the origin of the MR. Successively, the clip arms are placed, at about 120°, and the mitral leaflets are captured on the arms of the clip. The Color Doppler midesophageal intercommissural view is used to position the clip perpendiculary to MR origin (Panel H). Midesophageal long-axis LV outflow tract view is used to guide grasping and to evaluate leaflet capture (Panel I). Transgastric short-axis view demonstrates a double-orifice mitral valve (Panel L). Images courtesy of Abbott Vascular (c).