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A 60-year-old man who had catheter ablation due to atrial fibrillation underwent transcatheter mitral valve repair due to severe secondary mitral regurgitation. The procedure was performed under general anesthesia with two- (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) using the EPIQ CVx/X8-2t ultrasound system (Philips Medical Systems, Andover, Massachusetts). During the procedure, 2D-TEE demonstrated the previous iatrogenic atrial septal defect (iASD) at the mid-anterior location of the ovalis fossa (Figure 1A). To obtain sufficient height from the mitral annulus, the tip of a radiofrequency transseptal needle was positioned at the mid-posterior location of the ...
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