Figure 1.

Intraprocedural transesophageal echocardiogram images for patient 1. Panel A shows prolapse and flail with ruptured chordae of the A2 scallop (orange arrow). The left ventricular assist device inflow cannula is seen as well (yellow arrow). Panel B shows color Doppler across the mitral valve at Nyquist limit of 61 cm/second, suggesting severe mitral regurgitation (MR). Panel C shows a pulsed-wave (PW) Doppler through one pulmonary vein, showing systolic reversal, and was seen in all four pulmonary veins. After one MitraClip XTR was placed at the A2-P2 scallop (Panel D, green arrow), the severity of MR significantly decreased (panel E), and PW Doppler through the same pulmonary vein shows antegrade flow (Panel F) confirming mild MR. Mean gradient after clip placement is 2 mm Hg.