A 76-year-old male with diabetes mellitus, liver adenocarcinoma on chemotherapy was referred for NYHA class III dyspnea. Transesophageal echocardiogram showed severe primary mitral regurgitation with flail P3 segment. Aortic valve had moderate stenosis. Patient was evaluated by a multidisciplinary heart team and considering ongoing chemotherapy needs (with life expectancy > 1 year) and marked HF symptoms, recommendation was made to offer transcatheter edge to edge mitral valve repair using the MitraClip system and surveillance/follow up of his aortic valve disease. Careful NTR MitraClip alignment perpendicular to line of coaptation at medial commissure was performed using 3D en face color TEE prior to grasping. There was trace residual regurgitation. Left atrial pressure improved from mean 20 mmHg (V-wave 40 mmHg) to mean 8 mmHg (V-wave 11 mmHg). Mean diastolic trans-mitral gradient was 3 mmHg. Patient continues to have no dyspnea at 1-month follow up.