The combination of percutaneous transapical and transseptal closure of cardiac apex and prosthetic mitral paravalvular leak with loop technique

Article history: Received 11 October 2015 Accepted 18 October 2015 Available online 19 October 2015 Firstly, we decided to try the percutaneous transapical approach with a needle without left minithoracotomy. Under general anesthesia, we performed coronary angiography in order to not puncture the left anterior descending artery in apical region (Fig. 2). After that, under TEE and fluoroscopic angiographic guidance, transapical cannulation of the left ventricle from the sixth intercostal area and midclavicular region with a needle was performed and a 6 F sheath was inserted to