{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:37:31Z","timestamp":1786977451485,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,2,12]],"date-time":"2015-02-12T00:00:00Z","timestamp":1423699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p>In high\u2010risk or inoperable patients, implantation of MitraClip for treatment of severe symptomatic mitral regurgitation (MR) from central (A2\/P2 pathology, EVEREST patient) is effective in reducing symptoms and improving functional class. Extending the use of MitraClip to the non\u2010EVEREST patient is of considerable interest. MitraClip implantation for wide flail segments and non\u2010central MR is technically more challenging but represents an important and highly prevalent subset of patients. We present a case of an 82\u2010year\u2010old male referred to our institution for medically refractory primary MR. Trans\u2010esophageal echocardiogram demonstrated severe (4+) MR, annular dilatation, P3\u2009&gt;\u2009P2 mitral valve prolapse, malcoaptation, and wide flail gaps and widths. The patient's age, frailty, chronic kidney disease, and mild cognitive impairment rendered him a candidate for MitraClip therapy. Our target area, the areas of maximum flail (A3\/P3), proved too wide for grasping. Hence, the first clip was deployed medial to the target area. Subsequent deployment, in a sequential fashion (\u201czipper technique\u201d), was not technically feasible due to persistent instability of the target area. Consideration was given to an alternative approach by \u201canchoring\u201d our target area where the 2nd and 3rd clips were deployed lateral to the A3\/P3 segment in efforts to \u201canchor\u201d the maximum flail segment. This maneuver allowed final clip deployment into a more stable target area. Subsequent imaging demonstrated reduction in MR from 4+ to 1+ with preservation of a normal transmitral gradient. We report the first successful US case of four MitraClip implantation for the treatment of severe primary MR by \u201canchoring\u201d flail segments. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ccd.25811","type":"journal-article","created":{"date-parts":[[2015,1,5]],"date-time":"2015-01-05T15:11:50Z","timestamp":1420470710000},"page":"339-346","source":"Crossref","is-referenced-by-count":20,"title":["Multi\u2010\n                    <scp>M<\/scp>\n                    itra\n                    <scp>C<\/scp>\n                    lip therapy for severe degenerative mitral regurgitation: \u201cAnchor\u201d technique for extremely flail segments"],"prefix":"10.1002","volume":"86","author":[{"given":"Gagan D.","family":"Singh","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine University of California Davis Medical Center Sacramento California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of California Davis Medical Center Sacramento California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of California Davis Medical Center Sacramento California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,12]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2001.117277"},{"key":"e_1_2_5_3_1","first-page":"261","article-title":"Commissural closure for the treatment of commissural mitral valve prolapse or flail","volume":"17","author":"Lapenna E","year":"2008","journal-title":"J Heart Valve Dis"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.007"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.07.065"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.08.067"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009355"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.04.009"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.093"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(63)90375-2"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2007.01.028"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23431"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.03.077"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24645"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24538"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV9I10A204"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fccd.25811","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fccd.25811","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.25811","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T13:50:00Z","timestamp":1694699400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.25811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,12]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2015,8]]}},"alternative-id":["10.1002\/ccd.25811"],"URL":"https:\/\/doi.org\/10.1002\/ccd.25811","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,12]]}}}