Fig. 5.

Correct puncture height (a) and safe passage (b) during transseptal puncture. During SHD interventions, the height of the transseptal puncture is often crucial. For the MitraClip procedure, the septum should be perforated at a distance of 4 cm from the mitral annular plane. This measurement is best achieved in a four-chamber view at roughly 0° (marker in a). However, an echo angulation of about 35°/125° in xPlane best shows the aortic root and the bicaval view, enabling safe and precise puncture. Using fusion imaging, the precise site chosen in the four-chamber view is also demonstrated in the aortic root short axis view (b, marker 1 on echo and overlay image)