Transcatheter edge-to-edge repair with the PASCAL device for failed MitraClip procedure

A 79-year-old male with severe primary MR, due to flail of the lateral (P1) scallop with a commissural jet (Figure 1A), underwent attempted transcatheter edge-to-edge repair (TEER) with the MitraClip system (Abbott). The transseptal puncture was performed in the mid-position in the bicaval view and in the mid-posterior position in the short-axis view (Figure 1B), with a transseptal puncture height of 4 cm (Figure 1C). The MitraClip system was noted to have an anterior-to-posterior trajectory (aorta hugger) (Figure 1D, Figure 1E). Correcting the aorta hugger trajectory − using the “+” knob on the steerable guide catheter to move ...