Author + information
- Received November 5, 2018
- Revision received March 4, 2019
- Accepted March 26, 2019
- Published online October 7, 2019.
- Jeroen J. Bax, MD, PhDa,∗ (, )
- Philippe Debonnaire, MD, PhDb,
- Patrizio Lancellotti, MD, PhDc,d,
- Nina Ajmone Marsan, MD, PhDa,
- Laurens F. Tops, MD, PhDa,
- James K. Min, MDe,
- Niccolo Piazza, MDf,
- Jonathon Leipsic, MDg,
- Rebecca T. Hahn, MD, PhDh and
- Victoria Delgado, MD, PhDa
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDepartment of Cardiology, Sint-Jan Hospital, Bruges, Belgium
- cInterdisciplinary Cluster for Applied Genoproteomics (GIGA) Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
- dGruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
- eDepartment of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York
- fDepartment of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
- gSt. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- hColumbia University Medical Center and New York Presbyterian Hospital, New York, New York
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, the Netherlands.
• Transcatheter interventions for mitral regurgitation are a therapeutic breakthrough for patients with contraindications for surgery.
• Multimodality imaging is key to select the patients for each transcatheter device.
• Echocardiography and computed tomography are the imaging techniques that can answer all the preprocedural questions.
• Echocardiography is the main imaging technique for procedural guidance and important aid to fluoroscopy.
Transcatheter therapies to treat mitral regurgitation are rapidly developing. Currently, there are several devices commercially available to treat mitral regurgitation. The underlying cause of mitral regurgitation and specific anatomical aspects of the mitral valve and surrounding structures are considered when patients with symptomatic severe mitral regurgitation for transcatheter mitral valve therapies are selected. Multimodality imaging plays an important central role in the selection of patients, providing information about the mechanism of mitral regurgitation, the anatomy of the mitral valve and spatial relationships with the coronary sinus, the circumflex coronary artery and left ventricular outflow tract and to predict the procedural outcomes. During the transcatheter procedure, transesophageal echocardiography and fluoroscopy are key for monitoring the procedural steps to maximize the outcomes and minimize the complications. This paper provides a comprehensive review of the most important aspects to visualize in order to appropriately select patients for transcatheter mitral valve repair and replacement and to guide the procedure for the different transcatheter devices.
The Department of Cardiology of the Leiden University Medical Center has received grants from Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr. Bax has received speaker fees from Abbott Vascular. Dr. Ajmone Marsan has received speaker fees from Abbott Vascular. Dr. Min has received funding from Dalio Foundation, U.S. National Institutes of Health, and GE Healthcare; and serves on the Advisory Boards of Arineta and GE Healthcare. Dr. Piazza is a consultant for HighLife and Microport. Dr. Leipsic has received support from Edwards Lifesciences, Medtronic, Abbott, and Neovasc through his institution; and is a consultant for Circle CVI. Dr. Delgado has received speaker fees from Abbott Vascular. Dr. Hahn is a speaker for Boston Scientific and Bayliss; is a speaker and consultant for Abbott Vascular, Edwards Lifescience, Philips Healthcare, and Siemens Healthineers; and is a consultant for 3Mensio, Medtronic, and Navigate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 5, 2018.
- Revision received March 4, 2019.
- Accepted March 26, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.