Figure 3: Three-dimensional Transoesophageal Echocardiogram Guidance During MitraClip® Implantation.

(A) After transseptal puncture, the position and distance to the mitral valve is measured. A high and posterior puncture is aimed. (B) Orientation of the clip in the mitral valve (MV), perpendicular to the MV opening, assessed by three-dimensional transoesophageal echocardiogram (3D-TOE), from the left atrium (LA). (C) Final result after MitraClip implantation from the LA with two MV orifices, mimicking the Alfieri’s surgical edge-to-edge leaflet technique.