Transcatheter mitral valve repair in a patient with prior atrial septal defect occlusion

Figure 1. Transcatheter mitral valve repair after prior MitraClip therapy and atrial septal defect closure. A) Transoesophageal echocardiography (TEE) showing prior atrial septal occluder (ASO) and no space posterior to the ASO for safe transseptal puncture. B) Fluoroscopy showing a transseptal puncture through an ASO (arrow). C) Fluoroscopy showing predilatation with 12 × 40 mm balloon (arrow). D) TEE with three-dimensional (3D) imaging shows a steerable guide catheter through the ASO (arrow). E) Fluoroscopy showing deployment of an additional clip (arrow) through the ASO. F) TEE showing trivial MR (arrows) after additional clips. G) 3D-TEE showing new iatrogenic defect (arrow). H) ...