REVIEW  INTERVENTIONAL IMAGING 

Minerva Cardiology and Angiology 2021 December;69(6):684-706

DOI: 10.23736/S2724-5683.21.05691-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Transcatheter mitral valve interventions: pre-procedural planning and intra-procedural guidance

Antonio BOCCELLINO ¹, Francesco MELILLO ¹, Francesco ANCONA ¹, Antonio NAPOLANO ¹, Giacomo INGALLINA ¹, Cristina CAPOGROSSO ¹, Stefano STELLA ¹, Paolo DENTI ², Francesco F. FALETRA ³, Eustachio AGRICOLA ^{1, 4} ✉

¹ Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Italy; ² Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy; ³ Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland; ⁴ Vita-Salute San Raffaele University, Milan, Italy

Mitral regurgitation is the most prevalent valve disease worldwide. Percutaneous mitral valve interventions are emerging as alternative options for high-risk patients with severe mitral regurgitation not eligible for conventional surgery. Accurate patient selection is based on a detailed pre-procedural multimodality imaging evaluation. Morphology and functional anatomy of the mitral valve should be evaluated to determine the feasibility of treatments and to identify the best therapeutic approach. The procedures are guided by fluoroscopy, transesophageal echocardiography and fusion imaging, ensuring a continuous communication between the interventionalist and the imaging specialist. The present review will cover the pre-procedural planning and the intra-procedural guidance of the most used transcatheter approaches in the setting of native mitral valve regurgitation: edge to edge repair, percutaneous direct and indirect annuloplasty, transapical beating-heart chordal implantation and transcatheter mitral valve replacement.

KEY WORDS: Transcatheter mitral intervention; 3D-echocardiography; Multimodality imaging; Transoesophageal echocardiography