case_images: PMC11668173_01
case_images: (A) Transthoracic echocardiography on heart failure admission showed significant mitral regurgitation. (B) Transoesophageal echocardiography (TEE) with x-plane imaging before advancing steerable guide catheter (SGC) to right atrium (RA) revealed no structure in RA. (C) TEE immediately after advancing SGC to RA demonstrated a floating abnormal structure in RA. (D, E) Fluoroscopic imaging and 3D TEE during the structure aspiration in RA, respectively. (F) The aspirated structure was pathologically proven as thrombus later. (G) TEE after thrombus aspiration showed no structure in RA. (H) Fluoroscopic imaging after MitraClip implantation. Red circle indicates the thrombus in RA.
case_images: ytae661f1.jpg
case_images: PMC11668173_01_ytae661f1.jpg
case_images: ytae661-F1
case_images: An 86-year-old male underwent MitraClip (Abbott Vascular, CA) implantation through the right femoral vein for significant ventricular functional mitral regurgitation (MR) because of his high surgical risk (Figure 1A). Jude Medical, MN) (Figure 1B), when 24 Fr steerable guide catheter (SGC) was advanced to RA along Amplatz Super Stiff guidewire (Boston Scientific, MA), transoesophageal echocardiography (TEE) demonstrated a floating structure with 24 mm length in RA (Figure 1C and Supplementary material). TEE and fluoroscopic guidance (Figure 1D-F). Transoesophageal echocardiography revealed no structure in RA after aspiration (Figure 1G), and then SGC was removed for the purpose of washing out a potential thrombus inside it. Subsequently, MitraClip G4-NTW was successfully placed at A2-P2 without further device-related complications, resulting in less-than-mild degree of residual MR (Figure 1H).