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

Figure 7

A 79-year-old male patient was referred for a history of chronic dyspnea (New York Heart Association functional class IV. (a) 3D enface view of the MV demonstrating a central cleft-like indentation with a prolapse lateral P2 (P2 (L) and a prolapse medial P2 (P2 (M). (b, c) 2D CDF TEE showing two dominant regurgitant jets (VCW: 7 mm and 6 mm, resp.) originating from the two prolapse P2 segments and a mild jet (VCW: 2 mm) from the central P2 indentation on bicommissural view and LVOT view. (d) Heart team decision was made on transapical ValveClamp implantation after his being deemed too high risk for surgical intervention. Implantation of the first clamp led to correction of the medial P2 segment, while the lateral P2 segment remained prolapse with a significant residual MR jet. (e) After implantation of the second clamp at the P2 segment, prolapse segments and regurgitant orifice were corrected and leaflet coaptation was preserved. (f) 2D CFD TEE showing mild residual jets (this case was diagnosed and treated before the TrueVue technique was commercially available).