Patient Selection for Mitral Transcatheter Edge-to-Edge Repair

Mitral regurgitation (MR) is one of the most common valvular heart diseases, with many patients remaining non-suitable for surgical interventions. Transcatheter edge-to-edge repair (TEER) is a rapidly evolving procedure that allows safe and effective reduction of MR in high-risk patients. However, adequate patient selection through clinical assessment and imaging modalities remains a key factor for procedural success. In the following review, we highlight recent developments in TEER technologies that are expanding the target population and currently available imaging modalities that allow detailed evaluation of the mitral valve and surrounding structures for optimal patient selection.

Echocardiographic Imaging of the Mitral Valve for Transcatheter Edge-to-Edge Repair

Echocardiography continues to be the most effective imaging tool for the diagnosis and follow-up of mitral valve disease. This review addresses the use of transthoracic echocardiography and transesophageal echocardiography in the planning and guidance of transcatheter mitral valve therapies. Many of the echo-imaging guidance techniques are applicable to transcatheter intervention as a whole. However, given that the MitraClip is the only device approved for mitral regurgitation at present, specific attention is paid to this procedure, with additional focus on the guidance of noncentral repair. The imaging techniques discussed will be applicable to future devices.

The role of echocardiography during mitral valve percutaneous interventions

Transesophageal echocardiography is routinely used to guide percutaneous interventions involving the mitral valve. Mitral balloon valvuloplasty for rheumatic mitral valve stenosis (MS) was the first percutaneous intervention to gain wide acceptance. New techniques have been developed to treat degenerative and functional mitral regurgitation (MR) as well as paravalvular mitral leak (PVML). This review describes the use of echocardiography for transcatheter treatment of MS, MR, and PVML.