Advances in Procedural Echocardiographic Imaging in Transcatheter Edge-to-Edge Repair for Mitral Regurgitation

Abstract

Transcatheter edge-to-edge repair (TEER) therapy is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for selected patients with symptomatic severe or moderate-severe mitral regurgitation (MR). Echocardiography, in particular transesophageal echocardiography (TEE), plays a critical role in procedural planning and guidance for TEER. Recent innovations and advances in TEE techniques including three-dimensional (3D) imaging, unlimited x-plane imaging, live 3D multiplanar reconstruction, as well as transillumination imaging with color Doppler and transparency rendering have further enhanced procedural imaging for TEER, especially for complex diseases including commissural defects, clefts, and multi-segment pathologies. This review discusses the technology of these advanced procedural imaging techniques and provides a “step-by-step” guide on how to apply them during the TEER procedure with a focus on their added values in treatment of complex valve lesions.

Echocardiographic Imaging in Transcatheter Structural Intervention

“…Novel 3D techniques have since been developed, including multiplane (with unlimited plane combinations), live 3D-multiplanar reconstruction (3D-MPR), and photorealistic imaging, to better assist in TSHI. 12 Multiplane imaging allows for simultaneous views of separate planes with an unlimited combination of tilting and rotation between them, allowing for thorough interrogation of cardiac structures. Live 3D-MPR allows for real-time 2-dimensional (2D) visualization of structures in multiple views.…”

Radiation Exposure of Interventional Echocardiographers

“…Structural heart disease (SHD) intervention is a rapidly growing field of cardiovascular medicine. With the advances in SHD intervention techniques, SHD imaging, in particular echocardiography, 1 undoubtedly plays a central role in a variety of SHD interventional procedures ranging from transcatheter left atrial appendage occlusion 2 to transcatheter aortic valve replacement (TAVR) 3 and transcatheter edge-to-edge repairs (TEERs) of mitral 4 and tricuspid regurgitation. 5 SHD imagers are key players in the heart team.…”

Imaging for Transcatheter Mitral Valve Edge-to-Edge Repair for an Unusual Cause of Cardiogenic Shock

“…The advent of three-dimensional echocardiography has enabled an intuitive visualization of the MV pathophysiological features and the ability to guide the interventional procedures. 2 transcatheter edge-to-edge repair is increasingly being utilized in patients with MV prolapse and flail. 3 However, little has been reported about their application in patients with MV perforation.…”