Percutaneous Mitral Valve Repair: Multi-Modality Cardiac Imaging for Patient Selection and Intra-Procedural Guidance

Abstract

Percutaneous mitral valve repair is an important procedure for patients at high risk of surgical mitral valve repair. Multi-modality Cardiac Imaging plays a key role in these procedures. MitraClip is the first and most utilized percutaneous mitral repair device and experience is has grown to treat not only typical but atypical and complex lesions. Cardioband is an emerging percutaneous annuloplasty system with promising early results. This review will focus on the comprehensive multi-modality cardiac imaging for patient selection and intra-procedural guidance of the MitraClip and Cardioband systems.

Imaging the mitral valve: a primer for the interventional surgeon

“…MR severity can also be objectively assessed using quantitative variables, such as regurgitant volume (RVol), regurgitant fraction (RF) and effective regurgitant orifice area (EROA). These measurements can be performed using the proximal isovelocity surface area (PISA) method (not recommended for eccentric jets, multiple jets or complex and elliptical regurgitant orifices), quantitative Doppler analysis or 3D color Doppler VC planimetry (15). I n r e c e n t y e a r s , c a r d i a c m a g n e t i c r e s o n a n c e imaging (CMR) has emerged as an adjunct to primary echocardiographic analysis (16).…”

“…As discussed below, multi-modality cardiac imaging plays an (19,20). TEE is also used for anatomic screening and procedural planning (15). For instance, the biplane commissural view interrogates the MV across the commissures and can be useful for analyzing valvular anatomy at the grasping location and planning the "grasping view" (Figure 6).…”

“…Here, TEE can also be used to evaluate the position of the artery at the level of the anterolateral trigone. Finally, MDCT can be used to optimize the location of the transseptal puncture (4,15).…”

Percutaneous mitral valve repair in acute mitral regurgitation: case report and review of the literature

“…Beyond procedural challenges, the main issue is the balance between a relevant residual MR due to the highly mobile and redundant leaflets and a resultant iatrogenic mitral stenosis owing to extensive grasping with multiple clips. However, the introduction of MitraClip XTR device, with a wider reach and longer clip arms than NTR, has broadened the "graspable" MV anatomies, including Barlow's disease, as documented by a few case series [15][16][17] . Nonetheless, myxoid degeneration appears early in life and patients are usually referred for surgery due to young age and low risk, on the contrary fibroelastic deficiency affects elderly people with significantly different operative risk.…”

“…Hahn [27] listed the echocardiographic features associated with ideal and challenging anatomies and highlighted a few relative contraindications. The absolute contraindications include severe and extended calcifications of the grasping zone, short leaflet length (< 7 mm) and small baseline MV area (< 3.5 cm²) [15] .…”