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Updated: Jul 8, 2025

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

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Mitral Valve Interventions for Hypertrophic Obstructive Cardiomyopathy.

Mony Shuvy¹, Yael Yan Postell¹, Shemy Carasso¹

¹Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.

The Canadian Journal of Cardiology

|December 18, 2023

Summary

Hypertrophic obstructive cardiomyopathy (HOCM) involves the mitral valve (MV). Transcatheter edge-to-edge repair (TEER) offers a promising new treatment for reducing mitral regurgitation and left ventricular outflow tract obstruction in HOCM patients.

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Published on: May 26, 2023

Area of Science:

Cardiology
Cardiac Surgery
Interventional Cardiology

Background:

The mitral valve (MV) is integral to hypertrophic obstructive cardiomyopathy (HOCM) pathophysiology.
Systolic anterior motion (SAM) of the MV causes dynamic left ventricular outflow tract (LVOT) obstruction in most HOCM patients.
Mitral regurgitation (MR) in HOCM often necessitates specific MV interventions.

Purpose of the Study:

To review the MV's role in HOCM pathogenesis.
To discuss current medical and surgical therapies for HOCM.
To explore novel mitral valve interventions, particularly transcatheter edge-to-edge repair (TEER.

Main Methods:

Review of existing literature on MV disease in HOCM.
Discussion of surgical myectomy and alcohol septal ablation.
Emphasis on the application and outcomes of TEER for HOCM.

Main Results:

Surgical myectomy with MV modifications is often required for durable LVOT obstruction and MR relief.
TEER is an effective and safe emerging option for HOCM.
TEER reduces SAM, potentially alleviating LVOT obstruction and MR.

Conclusions:

The MV apparatus is a key target in HOCM management.
TEER presents a promising therapeutic avenue for HOCM patients, especially those at high risk for other procedures.
A treatment algorithm for TEER in HOCM is proposed.