The posterior leaflet of the mitral valve has two indentations that generally divide the leaflet into three scallops. It is not uncommon that abnormal deep, cleft-like indentations are associated with significant mitral regurgitation (MR). Moreover, the presence of cleft-like indentations is a frequent cause of residual MR after MitraClip® (Abbott Vascular, Santa Clara, CA, USA) implantation, mainly in functional MR. In the presence of advanced tethering, the implantation of one clip in the central position may open a cleft-like indentation.
When a significant MR jet originates from a deep indentation, two convergent clips can be implanted on ...
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