Journal of Echocardiography

, Volume 17, Issue 2, pp 84–94 | Cite as

Changes in dynamic mitral valve geometry during percutaneous edge–edge mitral valve repair with the MitraClip system

  • Thilo NoackEmail author
  • Philipp Kiefer
  • Linda Mallon
  • Philipp Lurz
  • Carmine Bevilacqua
  • Joergen Banusch
  • Fabian Emrich
  • David M. Holzhey
  • Mani Vannan
  • Holger Thiele
  • Friedrich-Wilhelm Mohr
  • Michael Andrew Borger
  • Joerg Ender
  • Joerg Seeburger
Original Investigation



The aim of this study was to quantify the acute dynamic changes of mitral valve (MV) geometry throughout the cardiac cycle—during percutaneous MV repair with the MitraClip system by 3-dimensional transesophageal echocardiography (3D TEE).


The MV was imaged throughout the cardiac cycle (CC) before and after the MitraClip procedure using 3D TEE in 28 patients (mean age, 77 ± 8 years) with functional mitral regurgitation (FMR). Dynamic changes in the MV annulus geometry and anatomical MV orifice area (AMVOA) were quantified using a novel semi-automated software.


Percutaneous MV repair decreased anterior–posterior diameter by up to 9% (at 50% of CC; from 34.5 to 31.9 mm; p < 0.001) throughout the CC and increased the diastolic lateral–medial diameter by up to 7% (at 60% of the CC; from 39.7 to 42.3 mm; p < 0.001), whereas the annular circumference and area were not significantly affected. Annulus sphericity index was reduced up to 13% (at 50% of the CC; from 0.89 to 0.78, p < 0.001). The AMVOA also decreased during systole, the maximum decrease being from 0.6 to 0.2 mm2 (at 0% of CC; p = 0.007), and during diastole the maximum decrease being from 4.6 to 1.6 cm2 (at 50% of CC; p < 0.001).


Percutaneous MV repair reduces the MR by an improved coaptation of MV leaflets joint with a simultaneous indirect reduction of anterior–posterior diameter. Further, the MitraClip procedure leads to a reduction of AMVOA of more than 60% during diastole.


Mitral valve geometry MitraClip Mitral regurgitation 3D echocardiography 


Compliance with ethical standards

Conflict of interest

Drs Noack and Vannan have received a speaker honorarium from Siemens Healthcare. Philipp Kiefer, Linda Mallon, Philipp Lurz, Carmine Bevilacqua, Joergen Banusch, Fabian Emrich, David M Holzhey, Holger Thiele, Friedrich-Wilhelm Mohr, Michael Andrew Borger, Joerg Ender and Joerg Seeburger declare that they have no conflict of interest.

Research involving human participants

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

Video 1 Video shows the 3D TEE-based mitral valve model after the implantation of 2 clips in the leaflet segments of A2 and P2. Further, automatically model-based quantification of annular height to commissural width ration of the mitral valve is demonstrated (MP4 10774 kb)

12574_2018_398_MOESM2_ESM.docx (31 kb)
Supplementary material 2 (DOCX 30 kb)


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Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  • Thilo Noack
    • 1
    Email author
  • Philipp Kiefer
    • 1
  • Linda Mallon
    • 1
  • Philipp Lurz
    • 2
  • Carmine Bevilacqua
    • 3
  • Joergen Banusch
    • 3
  • Fabian Emrich
    • 1
  • David M. Holzhey
    • 1
  • Mani Vannan
    • 4
  • Holger Thiele
    • 2
  • Friedrich-Wilhelm Mohr
    • 1
  • Michael Andrew Borger
    • 1
  • Joerg Ender
    • 3
  • Joerg Seeburger
    • 1
  1. 1.Department of Cardiac SurgeryHeart Center Leipzig UniversityLeipzigGermany
  2. 2.Department of Internal Medicine/CardiologyHeart Center Leipzig UniversityLeipzigGermany
  3. 3.Division of AnesthesiologyHeart Center Leipzig UniversityLeipzigGermany
  4. 4.Marcus Heart Valve CenterPiedmont Heart InstituteAtlantaUSA

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