53 years old male with dilated cardiomyopathy (NYHA IV, EF 25%)

TEE showing severe left ventricular dysfunction and severe mitral regurgitation with asymmetrical tethering making predictable a difficult grasping of the anterior leaflet.

After multiple attempts of grasping using a number of tricks to reduce the motility of the anterior leaflet (Trendelemburg, adenosine, inotropes, VF induction..), it was decided to put a left Amplatz catheter inside the left ventricle in order to push the anterior leaflet and keep it stable during the grasping phase (figure).

After the deployment of a second clip, a good final result was obtained with a residual mild regurgitation. The patient was safely discharged without any complication.