Percutaneous left ventricular advanced support for ‘protected’ complex high-risk transcatheter mitral valve repair: a case series

Figures

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  Figure 1. Pre-procedural transoesophageal echocardiography showing severe mitral regurgitation due to tethering of the leaflets resulting in multiple jet, the major between A2 and P3 (intercommissural and outflow tract transoesophageal views). Images show the severely dilated and spherical left ventricle.

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  Figure 2. Intraprocedural transoesophageal echocardiography showing active Impella CP during mitral leaflets grasping by XTR MitraClip (intercommissural and outflow tract transoesophageal views).

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  Figure 3. Fluoroscopic image showing the deployed XTR MitraClip and the active Impella CP. No dislocation of cardiac resynchronization defibrillator leads occurred.

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  Figure 4. Post-procedural transthoracic echocardiography (A) and transoesophageal echocardiography (B) (intercommissural and outflow tract transoesophageal echocardiography views) showing the optimal result with residual mild mitral regurgitation.

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  Figure 5. Pre-procedural transoesophageal echocardiography (intercommissural and outflow tract views) showing degenerated leaflets and tethering of posterior mitral leaflets determining severe eccentric mitral regurgitation (A). Three-dimensional surgical visualization showing multiple mitral regurgitation jets between A2-P1 and A2-P3 scallops (B).

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  Figure 6. Fluoroscopic guidance during XTR MitraClip deployment with Impella CP active across the aortic valve.

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  Figure 7. Intraprocedural transoesophageal echocardiography showing active Impella CP before mitral leaflets grasping by XTR MitraClip (intercommissural and outflow tract transoesophageal views).

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  Figure 8. Final transoesophageal echocardiography demonstrating trivial/mild mitral regurgitation after XTR MitraClip delivery and Impella CP removal in intercommissural and outflow tract views (A) and three-dimensional surgical visualization (B).

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