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Rodinò et al. Mini-invasive Surg 2020;4:70 I http://dx.doi.org/10.20517/2574-1225.2020.55 Page 7 of 10

A B

C D

Figure 3. Preoperative evaluation with 2D (A, C, D) and 3D (B) TEE. White arrows indicate P2 prolapse; red arrow indicates P1-P2 cleft.
Color TEE (C, D) shows 2 regurgitation jets (green arrows) with the main one localized at the level of P2 prolapse, producing severe mitral
regurgitation

A B C

Figure 4. Transseptal puncture under fluoroscopic (A) and TEE (B) guidance. A puncture 4 to 4.5 cm above the MV plane in a
posterosuperior position allows good maneuverability of the delivery system. After the transseptal puncture, a guidewire is introduced
in the left atrium and then in the left superior pulmonary vein (C)

second clip lateral to the first one, with a slight clockwise orientation, in P1-A2 position [Figure 6]. At the
end of the procedure, mild residual MR was detected with a mean gradient less than 5 mmHg [Figure 7].