Leaflet-to-Annuloplasty Ring Clipping for Severe Mitral Regurgitation.

A n 86-year-old man presented with recurrent heart failure and severe mitral regurgitation in the setting of previous surgical mitral repair for degenerative valve disease. Surgery had consisted of placement of a 32-mm CarpentierEdwards Physio II annuloplasty ring (Edwards Lifesciences, Irvine, California). Transesophageal echocardiography demonstrated a large anterior leaflet (Figure 1A, arrow), poor coaptation of the anterior leaflet with the annuloplasty ring, a markedly deficient posterior leaflet (Figure 1B, arrow), and severe residual mitral regurgitation (Figure 1C, arrow) between the tip of the anterior leaflet and the annuloplasty ring (Figure 1D, arrow). Using a transfemoral, transseptal approach, a MitraClip (Abbott Vascular, Santa Clara, California) (Figures 1E and 1F, arrows) was implanted to affix the anterior leaflet to the annuloplasty ring (Figure 1G, arrow). This implantation