84-year-old 👩🏻 presented with severe symptomatic MR, NYHA Class III, and recurrent decompensated heart failure with 3 hospitalizations within the last 6 months. The anatomy was complex for M-TEER, with CLI and a relatively small mitral valve area (~4.10 cm²), creating a very narrow margin between achieving adequate MR reduction and avoiding significant mitral stenosis. Position the PASCAL ACE device was challenging we couldn’t reduce MR by positioning the device central to medial but when we positioned the device more lateral, we achieved an excellent final outcome: • MR reduced from severe to trivial • Final mean transmitral gradient of only 3 mmHg at HR 80 bpm