title: "First-in-man" MitraClip via pulmonary vein access through a right mini-thoracotomy in a patient with agenesis of the inferior vena cava.
abstract: OBJECTIVE
  Transcatheter mitral valve repair has become a promising alternative treatment option for severe symptomatic mitral regurgitation in patients at high risk for open heart surgery with heart-lung bypass.
  
  
  RESULTS
  We describe the first successful procedure of mitral clipping through a right lateral mini-thoracotomy via the right upper pulmonary vein in a patient with an agenesis of the inferior vena cava. The set-up of the MitraClip system on a separate table located at 70¡ on the right side of the patient and the fixation of the steerable sheath at the entry into the thorax with constant posterior pressure enabled clip implantation using the usual manoeuvres with marked reduction of the mitral insufficiency.
  
  
  CONCLUSIONS
  The access through the right upper pulmonary vein using the usual right mini-thoracotomy enabled a successful mitral clipping even in the absence or occlusion of the inferior vena cava.
authors.affiliation: Department of Cardiology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiroch
authors.forename: Hilmar
authors.initials: H
authors.lastname: Brinkmann
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Koudonas
authors.forename: Marc
authors.initials: M
authors.lastname: Vorpahl
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Herbert O
authors.initials: HO
authors.lastname: Vetter
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D006801:Humans; D008297:Male; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011667:Pulmonary Veins; D013908:Thoracotomy / Q000379:methods; D014682:Vena Cava, Inferior / Q000002:abnormalities*