Mitral paravalvular leak closure by antegrade percutaneous approach: Three-dimensional transesophageal echocardiographic guided multiple Amplatzer implantation by a modified sequential anchoring based technique

We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, that was managed by antegrade trans-septal, single stage, percutaneous approach. Real-time three-dimensional transesofageal echocardiographic guidance was crucial to ensure successful re-crossings of the target defect and the optimal anatomical closure.