Be Prepared for the Unexpected

Transesophageal echocardiography plays a central role in the evaluation and guidance of mitral valve interventions. Our case highlights the importance of thorough intraprocedural valve evaluation using 3-dimensional and multiplanar reconstruction transesophageal echocardiography, discovering an unexpected mechanism for mitral regurgitation, to guide an alternative intervention strategy by an experienced interventional team. (Level of Difficulty: Intermediate.)