fig5

Figure 5. Axial alignment of the clip delivery system. A: biplane imaging, starting from the commissural view as the main view and the LAX view as the derived one, allows for medial-lateral and anterior-posterior clip adjustments. The perpendicularity of the system with respect to the MV plane should be achieved in both views; B-D: fusion imaging showing the same procedural step: RAO CRA fluoroscopic projection with superimposed commissural view with (D) and without (C) color. LAA: left atrial appendage; LV: left ventricle; LA: left atrium; MV: mitral valve