Edge-to-Edge Mitral Valve Repair

Abstract

Three-dimensional transesophageal echocardiography (3D TEE) is ideally suited to guide transcatheter edge-to-edge mitral valve repair (TMVR). 3D TEE is indispensable for pre procedural evaluation of the pathology of degenerative and functional mitral valve (MV) regurgitation, and for accurately localizing and characterizing the site(s) of regurgitation which may help determine the number of MitraClips needed. 3D TEE provides a panoramic enface view of the “operating theatre” that besides the entire MV encompasses the interatrial septum, and ostia of the left atrial appendage and left superior pulmonary vein key to execution of the procedure. 3D TEE also provides contextual anatomical guidance in real time during transcatheter interventions. Moreover, catheters, sheaths, wires and devices are far better seen in the 3D space than in a 2D tomographic space. All of the aforementioned can be displayed from a single acoustic window without need for excessive probe manipulation which facilitates catheter and device navigation. It is therefore not surprising that 3D TEE has been shown to be superior to 2D TEE in guiding many of the steps involved in TMVR. A critical step that is guided solely by 3D TEE is assuring perpendicularity of the open arms of the advancing MitraClip to line of malcoaptation which is very challenging for 2D TEE particularly in patients with non-central MR.