Peri-interventional echo assessment for the MitraClip procedure

Worldwide, there have been more than 6500 MitraClip procedures performed to treat either functional or degenerative mitral regurgitation (MR). The MitraClip procedure is the only available percutaneous device available to reduce MR by creating a double mitral valve (MV) orifice and decreasing MV annular diameter. As the mitral leaflets cannot be assessed by fluoroscopy, procedural success is dependent upon echocardiographic guidance. In this review, we describe the assessment necessary to determine eligibility for the MitraClip procedure. This includes accurate assessment of MR and detailed analysis of MV morphology by 2D and 3D echocardiography. In addition, each of the intraprocedural steps involved in the deployment of this device and the guidance of these steps by 2D and 3D echo are described in detail, along with the use of echo to detect procedural complications. Thus the focus of this review is on the peri-interventional echocardiographic assessment before, during, and after the MitraClip procedure.