Real-Time Monitoring and Step-by-Step Guidance for Transapical Mitral Valve Edge-to-Edge Repair Using Transesophageal Echocardiography

Figure 3

Transapical puncture and introducing the valve-crossing device. (a) X-plane view shows the guidewire enters LA through the mitral orifice (orange arrowhead). After that, a 6F guidewire is exchanged and advanced into LV and LA on a similar view. (b) Arrowhead. (c) 3D enface view + X-plane view show the introducer sheath is inserted coaxially to the LV and the insertion depth is approximately 3 cm (orange line). (d) The valve-crossing device is loaded into the introducer sheath and can be shifted in full directions (green arrows) within a reasonable scope of the MV orifice. (e) Coaxial advancement of the introducer sheath into the center of LA along the rod of valve-crossing device. AP: apex.

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