fig4

Figure 4. A and B: show two right fluoroscopic 2-chamber views during percutaneous tricuspid MitraClip™ procedure, useful to advance the catheters towards the tricuspid valve and to calculate the trajectories to address the targeted commissure. Light green dotted line traced in Panel A-B is the hypothetical line of coaptation between the anterior and the septal leaflet; C and D: show two en-face fluoro views during the same procedure, useful to guide catheter navigation within the valve area and to position the MitraClip™ in the anteroseptal commissure (ASC), closest to the tricuspid annulus. AL is anterior leaflet (dotted line); PSC (yellow) posteroseptal commissure with SL septal leaflet (dotted line). Light green dotted line traced in Panel D is the line joining the aortic valve (ASC) and the inferior vena cava, reflecting the theoretical line of coaptation between the anterior and the septal leaflet. Arrows indicate traction forces on the leaflets done by the edge-to-edge percutaneous repair. The white dotted circle depicts the theoretical tricuspid ring. *Intracardiac echocardiography (reprinted with permission from Pozzoli et al.^[47]). AVP: aortic valve prosthesis; MVP: mitral valve prosthesis