Catheter-Based Repair of Mitral Valve Insufficiency

  • Francesco Fulvio Faletra
  • Gila Perk
  • Natesa G. Pandian
  • Hans-Joachim Nesser
  • Itzhak Kronzon


Catheter-based percutaneous edge-to-edge repair using the MitraClip device (Abbott Vascular; Abbott Park, IL, USA) is a well-established, effective, and safe procedure that can be utilized in selected patients with mitral regurgitation (MR). The procedure mimics Alfieri’s surgical technique, bringing the anterior and posterior leaflets together from beneath the valve with a metallic stitch. Echocardiographic evaluation before the procedure is of paramount importance in defining the complex morphology of the valve and in detecting target leaflet lesion. Intra-procedural monitoring (i.e. delivery and placement of the clip) is usually performed under fluoroscopic and two-dimensional transoesophageal echocardiography. With the introduction of real-time three-dimensional transesophageal echocardiography (3D TEE), it appeared evident that the new technique would provide unique additional anatomical information both in selecting patients and guiding the procedure. In the selection of patients, the complex spatial structure of the valve is displayed as it actually is, allowing a precise assessment of the culprit as well as of secondary lesions. During the procedure, it has the unique ability to depict the “whole” scenario in which the procedure takes place in a single three-dimensional, real-time, easily understandable perspective. In this chapter we describe the normal mitral valve anatomy as displayed by 3D TEE, the 3D TEE pre-procedural characterization of valve morphology and the growing role of RT TEE in any individual steps of this complex procedure.


Mitral Valve Posterior Leaflet Functional Mitral Regurgitation Guide Catheter Regurgitant Orifice 
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Supplementary material

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Video 3.1 Mitral valve prolapse of the posterior leaflet shown from above (AVI 4257 kb)
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Video 3.2 Mitral valve prolapse of the posterior leaflet shown from the right perspective (AVI 3915 kb)
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Video 3.3 Mitral valve prolapse of the posterior leaflet shown from the left perspective (AVI 3747 kb)
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Video 3.4 An “oblique” perspective showing an anatomical elliptical-shaped regurgitant orifice (AVI 7770 kb)
Video 3.5

Transseptal puncture (AVI 7770 kb)

Video 3.6

Left atrial positioning of the exchange guidewire and guide catheter (AVI 12096 kb)

Video 3.7

Alignment of the Mitral Clip arms perpendicular to the coaptation line (AVI 7380 kb)

Video 3.8

Capturing leaflets (AVI 21463 kb)

Video 3.9

A novel double orifice (AVI 8772 kb)

Video 3.10

Clip release (AVI 8341 kb)

Video 3.11

Withdraw of the guide catheter into the right atrium (AVI 9336 kb)

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Francesco Fulvio Faletra
    • 1
  • Gila Perk
    • 2
  • Natesa G. Pandian
    • 3
  • Hans-Joachim Nesser
    • 4
  • Itzhak Kronzon
    • 2
  1. 1.Department of CardiologyCardiocentro TicinoLuganoSwitzerland
  2. 2.Non-Invasive CardiologyLenox Hill HospitalNew YorkUSA
  3. 3.Tufts University School of MedicineBostonUSA
  4. 4.Department of Medicine ElisabethinenTeaching HospitalLinzAustria

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