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Page 22 of 23 Ancona et al. Mini-invasive Surg 2020;4:79 I http://dx.doi.org/10.20517/2574-1225.2020.80

After cannulation of the CS, a 9F delivery catheter is positioned distal in the GCV, as close as the antero-
lateral commissure of the MV. Then the arteriovenous anatomy is characterized through occlusive
venography and coronary angiography, allowing for the selection of the appropriate implant size. After
the distal anchor of the device is deployed, manual traction is applied to reshape the periannular tissue.
Ultimate device size and position are determined by maximal geometric reduction of the septo-lateral
dimensions and reduction of MR, as assessed by fluoroscopy and TEE (mainly mid-esophageal views and
3D MV en face view). Before final release, coronary angiography rules out coronary injuries/preservation
of coronary flow. The implant can be recaptured and repositioned. Procedural success strongly relies on the
variable distance/relationship between the CS and the posterior MV annulus, influencing effective annular
cinching.

CONCLUSION
Percutaneous MV therapies are increasingly emerging as safe alternatives for high-risk patients not suitable
for conventional open-heart surgery. Intraprocedural monitoring relies on the sapient integration of
fluoroscopy and echocardiography, highlighting the importance of the communication inside the cath lab
between the interventional imager and the interventional cardiologist in order to perform more effective
and safer procedures.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Ancona F, Stella S, Capogrosso C, Agricola E
Performed data acquisition, as well as provided administrative, technical, and material support: Melillo F,
Ingallina G, Boccellino A, Napolano A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
A written informed consent for publication was obtained.

Copyright
© The Author(s) 2020.

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