Percutaneous Transcatheter Edge-to-Edge MitraClip Technique: A Practical “Step-by-Step” 3-Dimensional Transesophageal Echocardiography Guide

Bushari, Limor Ilan; Reeder, Guy S.; Eleid, Mackram F.; Chandrasekaran, Krishnaswamy; Eriquez-Sarano, Maurice; Rihal, Charanjit S.; Maalouf, Joseph F.

doi:10.1016/j.mayocp.2018.10.007

Cited by 19 publications

(7 citation statements)

References 15 publications

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“…Up to date, publications dealing with PMVR in patients with CLI are only case reports of PMVR in the presence of anatomically complex mitral valve leaflet variations, such as, cleft‐like indentations, clefts, and tri‐leaflet mitral valves, 11‐14 while others consider the presence of cleft‐like indentations and pseudo‐clefts confounding factors, which precludes PMVR with the MitraClip system 16 . The prevalence of CLI in our study was about 14%, which was higher than in other published studies 9,10 .…”

Section: Discussionmentioning

confidence: 99%

“…In regard to the growing experience on applying PMVR in more complex valve morphologies only few case reports have been published reporting PMVR in the presence of anatomically complex mitral valve leaflet variations, such as, cleft‐like indentations, clefts and tri‐leaflet mitral valves, 11‐15 while others consider the presence of cleft‐like indentations and pseudo‐clefts confounding factors which precludes PMVR with the MitraClip system 16 …”

Section: Introductionmentioning

confidence: 99%

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Impact of cleft‐like indentations on procedural outcome of percutaneous edge‐to‐edge mitral valve repair

Körber

Friedrichs

Aydın

et al. 2020

Cathet Cardio Intervent

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Objectives and Background Percutaneous edge‐to‐edge mitral valve (MV) repair (PMVR) is broadly applied in high‐risk patients with relevant mitral regurgitation (MR). We investigated the incidence of cleft‐like indentations (CLI) and their impact on PMVR. Methods and Results In a retrospective single center analysis including 263 patients undergoing PMVR with the MitraClip®‐system between 11/2012 and 7/2016, MV anatomy was assessed by 3‐dimensional transesophageal echocardiography. CLI were present in 37/263 patients (14.1%). Of these, 62.2% had 1 CLI, 27% had 2 CLI, and 10.8% had 3 CLI, mostly concerning segment P2 or P2/3 of the MV. Baseline characteristics were similarly distributed. Interestingly, most patients with CLI suffered from secondary MR (n = 29, 78%). The number of deployed MitraClips was higher in patients with CLI (2 [1.25–2] vs. 2 [1, 2], p = .035), whereas procedural as well as clinical success was similar: MR grade (1.2 vs. 1.5, p = .061), vena contracta width (4.2 vs. 4.5 mm, p = .293), dPmean (4.2 vs. 4.0 mmHg, p = .618) at discharge and NYHA class at 30 days did not differ between groups. Periprocedural complications were rare and equally distributed between groups. At 30 days, MR reduction persisted in patients with CLI (95.8% of these selected patients had a MR grade ≤ 2). Conclusions CLI of the MV are common in patients undergoing PMVR, also when presenting mainly with secondary MR. While the number of clips needed to address MR is slightly higher in patients with CLI, procedural success rates appear not to be affected. PMVR seems to be a safe treatment option for patients with CLI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of cleft‐like indentations on procedural outcome of percutaneous edge‐to‐edge mitral valve repair

Körber

Friedrichs

Aydın

et al. 2020

Cathet Cardio Intervent

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“…One of the main limitations is that 2D echocardiography can only show one acquisition plane which sometimes leads to misunderstanding of the MV geometry. Recent developments in ultrasound devices allow the characterization of the complex anatomy of cardiac structures with great accuracy using three-dimensional (3D) echocardiographic images with great accuracy (6,7). In particular, real-time 3D transesophageal echocardiography (TEE) plays an indispensable role in the assessment and management of TMVr (8,9).…”

Section: Introductionmentioning

confidence: 99%

Role of 3D Transesophageal Echocardiography for Transcatheter Mitral Valve Repair—A Mini Review

Hirasawa

Izumo

2022

Front. Cardiovasc. Med.

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Edge-to-edge transcatheter mitral valve repair (TMVr) using MitraClip has been evolving rapidly in patients with severe mitral regurgitation (MR) at high surgical risk or having contraindications for surgery. Three-dimensional (3D) echocardiography plays an important role in the management of severe MR. In particular, 3D transesophageal echocardiography (TEE) imaging allows the evaluation of MV geometry and quantification of MR severity with dedicated software. Real-time 3D TEE is also commonly used to guide TMVr and facilitate the procedure. Further development of 3D echocardiography may help achieve safer and more beneficial results. The following article summarizes the current knowledge and the future perspectives of 3D TEE in TMVr.

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“…Transcatheter mitral valve (MV) interventions are progressively being introduced into clinical practice targeting a population of patients with mitral regurgitation (MR) deemed inoperable or at a prohibitive surgical risk [1]. Echocardiography is the imaging modality of choice for patient selection, intraoperative guidance, and assessment of procedural effect as well as potential complications for these therapies [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Monitoring and Step-by-Step Guidance for Transapical Mitral Valve Edge-to-Edge Repair Using Transesophageal Echocardiography

Pan

et al. 2021

Journal of Interventional Cardiology

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MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai). The first-in-human study of ValveClamp has demonstrated its early feasibility and effectiveness for the treatment of patients with degenerative MR. Transesophageal echocardiography (TEE) is the only imaging modality required for intraoperative guidance of ValveClamp implantation. Successful implantation depends on accurate localization and orientation of the clamp and efficient intraoperative communication between the echocardiographer and the intervention team. Thus, the focus of this review is on elaborating how two-dimensional (2D) and three-dimensional (3D) TEE are used in clinical practice to guide ValveClamp implantation and it may facilitate the understanding of simplicity and safety of this novel procedure. We also describe the implementation of several novel advancements in 3D TEE imaging, which improve the confidence of image interpretation for intraoperative guidance and expedite implantation times.

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Percutaneous Transcatheter Edge-to-Edge MitraClip Technique: A Practical “Step-by-Step” 3-Dimensional Transesophageal Echocardiography Guide

Cited by 19 publications

References 15 publications

Impact of cleft‐like indentations on procedural outcome of percutaneous edge‐to‐edge mitral valve repair

Impact of cleft‐like indentations on procedural outcome of percutaneous edge‐to‐edge mitral valve repair

Role of 3D Transesophageal Echocardiography for Transcatheter Mitral Valve Repair—A Mini Review

Real-Time Monitoring and Step-by-Step Guidance for Transapical Mitral Valve Edge-to-Edge Repair Using Transesophageal Echocardiography

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