EVEREST II Functional Mitral Regurgitation

  • Ehrin J. Armstrong
  • Reginald Low
  • Jason RogersEmail author


This case example describes in a step-by-step fashion the evaluation and management of severe MR in a patient with functional MR due to an inferior-basal left ventricular aneurysm in the setting of prior inferior myocardial infarction.


Mitral regurgitation MitraClip Functional mitral regurgitation Ventricular aneurysm 

Supplementary material


TTE: parasternal LAX w/o color. The parasternal long axis demonstrates significant tenting of the mitral leaflets below the level of the annulus (AVI 6289 kb)

Video 22.2

TTE: parasternal LAX w/color. There is a posteriorly directed jet of mitral regurgitation, consistent with functional MR (AVI 2752 kb)

Video 22.3

TTE: parasternal SAX. Short axis view shows that the MR has a central origin along the P2/A2 interface (AVI 4439 kb)

Video 22.4

TTE: apical 4C view. The apical four-chamber view shows biatrial enlargement and confirms a posteriorly directed jet of mitral regurgitation resulting from tenting of the posterior leaflet (AVI 4164 kb)

Video 22.5

TTE: 2C w/o color. In the apical two-chamber view, the echogenic inferobasal aneurysm is apparent, which is tethering the posterior leaflet (AVI 5200 kb)

Video 22.6

TTE 2C: w/color. The jet of mitral regurgitation is moderate to severe by color Doppler (AVI 2876 kb)

Video 22.7

TEE: bicommissural w/o color. The bicommissural view shows the large inferobasal aneurysm (AVI 5516 kb)

Video 22.8

TEE: bicommissural w/color. There is a significant jet of posterior MR resulting from tethering of the leaflets (AVI 3749 kb)

Video 22.9

TEE: 3C w/o color. The three-chamber view confirms a posteriorly directed jet originating at the A2/P2 interface (AVI 6664 kb)

Video 22.10

TEE: 3C w/color. There is a large vena contracta and a posteriorly directed jet (AVI 3806 kb)

Video 22.11

TEE: 4C w/o color. The four-chamber view shows tenting of the mitral valve leaflets. The annulus is also enlarged (AVI 4724 kb)

Video 22.12

TEE: 4C w/color. The regurgitant jet has a central origin (AVI 3657 kb)

Video 22.13

TEE: bicaval view. The transseptal needle is advanced across the interatrial septum in a superior and posterior direction (AVI 7853 kb)

Video 22.14

Biplane TEE. The MitraClip is advanced across the mitral valve (AVI 9640 kb)

Video 22.15

Biplane TEE. Biplane TEE is used to orient the direction of the grasping arms orthogonal to the line of leaflet coaptation (AVI 1682 kb)

Video 22.16

TEE: Bicom clip at deployment. Once positioning is confirmed, the device is deployed (AVI 2837 kb)

Video 22.17

TEE: Bicom view after clip deployment. Post-deployment, there is a residual jet of MR lateral to the site of clip attachment (AVI 2880 kb)

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Video 22.18 TEE. A second clip is advanced across the mitral valve (AVI 902 kb)
Video 22.19

TEE: biplane views. The second clip is deployed slightly lateral to the first clip (AVI 10431 kb)

Video 22.20

TEE: biplane Doppler views after second clip. Post-deployment, there is trace MR (AVI 1168 kb)

Video 22.21

Fluoroscopy. Pre-procedure, there is severe mitral regurgitation with associated severe left atrial enlargement and an inferobasal left ventricular aneurysm (AVI 21569 kb)

Video 22.22

Fluoroscopy. Post-procedure, there is trace MR, and the two MitraClip devices appear well seated on fluoroscopy (AVI 17401 kb)

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Video 22.23 TTE: parasternal LAX. Parasternal long axis view show the MitraClips positioned in the center of the valve (AVI 2013 kb)
Video 22.24

TTE: parasternal LAX w/color. There is trace mitral regurgitation and normal inflow around the MitraClip devices (AVI 1550 kb)

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Video 22.25 TTE: 4C w/o color. Apical 4C view shows the MitraClips oriented parallel to the mitral inflow (AVI 2075 kb)
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Video 22.26 TTE: 4C w color. There is double inlet Doppler flow around the MitraClip devices (AVI 1285 kb)

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Ehrin J. Armstrong
    • 1
  • Reginald Low
    • 2
  • Jason Rogers
    • 2
    Email author
  1. 1.Division of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA
  2. 2.Department of Cardiovascular MedicineUniversity of California, Davis Medical CenterSacramentoUSA

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