title: How should I treat a challenging case of MitraClip implantation?
abstract: BACKGROUND
  A 71-year-old woman affected by idiopathic dilated cardiomyopathy with normal coronary arteries and permanent atrial fibrillation was found to have severe mitral regurgitation at transthoracic echocardiography (TTE), due to annular dilatation and restricted motion of the posterior leaflet. Because of poor quality of life, high functional class (NYHA Class III) and the high risk of surgery, the patient agreed to undergo the implantation of a MitraClip device. During the procedure, the transoesophageal echocardiographic (TEE) images were of a poor quality since the view of the mitral valve in the mid-oesophageal and transgastric projections did not accurately show the valve leaflets and the convergence area of the regurgitation at colour Doppler, which is indispensable for the correct positioning of the clip.
  
  
  METHODS
  Physical examination, transthoracic echocardiography, transoesophageal echocardiography.
  
  
  METHODS
  Severe mitral regurgitation suitable for MitraClip implantation.
  
  
  RESULTS
  Transthoracic, and not transoesophageal, echocardiography approach during MitraClip procedure.
authors.affiliation: Cardiovascular Department, AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Duino
authors.forename: Luigi
authors.initials: L
authors.lastname: Fiocca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Elisa
authors.initials: E
authors.lastname: Cerchierini
authors.forename: Mauro
authors.initials: M
authors.lastname: Gori
authors.forename: Emilia
authors.initials: E
authors.lastname: D'Elia
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrero
authors.forename: Attilio
authors.initials: A
authors.lastname: Iacovoni
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Steven
authors.initials: S
authors.lastname: Smart
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozdag-Turan
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Liliya
authors.initials: L
authors.lastname: Paranskaya
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*