Possible Transmitral Pressure Gradient Elevation in MitraClip XTR.

A 74-year-old man presented with dyspnea due to severe mitral regurgitation (MR) caused by rupture of the chordae tendineae. Percutaneous edge-to-edge mitral valve repair was performed using the MitraClip system (Abbott Vascular, Santa Clara, CA). After leaflet grasping via an XTR clip, transesophageal echocardiography (TEE) revealed marked reduction of MR, but elevation of the transmitral gradient was detected no matter how the position of grasping was changed. Finally, we replaced the XTR to the NTR system. After leaflet grasping via an NTR clip, TEE revealed marked reduction of MR from severe to mild and an adequate transmitral gradient.