Related Experiment Video
Updated: Jan 8, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
4.3K
Three-Dimensional Echocardiographic Approach to Mitral Valve After Transcatheter Edge-to-Edge Repair.
Rishi Kumar1, Serena S Dasani1, Kara G Fields2
1From the Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth Houston, Houston, Texas.
Anesthesia and Analgesia
|December 15, 2025
Summary
A new 3D Orifice Area (3DOA) technique using transesophageal echocardiography (TEE) shows excellent agreement for measuring mitral valve area (MVA) after TEER compared to awake transthoracic echocardiography (TTE). This method is more reliable than traditional TEE pressure half-time (PHT) for assessing post-TEER MVA.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Echocardiography
Background:
- Transcatheter edge-to-edge repair (TEER) for mitral regurgitation relies on intraprocedural transesophageal echocardiography (TEE) for evaluation.
- Iatrogenic mitral stenosis (MS) is a risk after TEER, and conventional echocardiographic methods are limited by hemodynamic variability.
- A novel 3-dimensional (3D) Orifice Area (3DOA) technique is introduced to assess post-TEER mitral valve area (MVA).
Purpose of the Study:
- To evaluate the agreement between post-TEER MVA measurements using TEE 3DOA under general anesthesia (GA) and TEE pressure half-time (PHT).
- To compare these TEE-derived MVA measurements with MVA obtained by transthoracic echocardiography (TTE) PHT in awake patients.
Main Methods:
- Retrospective review of TEE and TTE images from 20 adult patients undergoing TEER (MitraClip).
- Comparison of MVA measurements: TEE 3DOA (GA) vs. TEE PHT (GA) vs. TTE PHT (awake).
- Agreement assessed using Bland-Altman analysis and Lin's concordance correlation coefficients.
Main Results:
- Excellent agreement was found between TEE 3DOA-derived MVA (under GA) and TTE PHT-derived MVA (awake) (concordance correlation coefficient: 0.95).
- Weak agreement was observed between TEE PHT-derived MVA and TTE PHT-derived MVA (concordance correlation coefficient: 0.46).
- TEE 3DOA measurements showed narrower limits of agreement compared to TEE PHT.
Conclusions:
- The TEE 3DOA technique demonstrates excellent agreement with awake TTE PHT for evaluating MVA after TEER.
- TEE PHT shows poor agreement with awake TTE PHT for post-TEER MVA assessment.
- Further validation in larger cohorts is recommended to establish the utility of 3D echocardiographic approaches post-TEER.
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