Transesophageal echocardiography for mitral valve transcatheter edge-to-edge repair in dogs using the V-Clamp device

The V-Clamp device is a canine-specific mitral valve (MV) implant delivered via transapical access that has been developed for transcatheter edge-to-edge repair in dogs. Transesophageal echocardiography (TEE) is an essential component of successful V-Clamp implantation as it both evaluates patient candidacy for the procedure and directly guides the intervention. A thorough TEE examination provides information on the mechanism of mitral regurgitation, anatomical characteristics of the MV apparatus, localizes the site of regurgitation relative to the MV segments, confirms mitral regurgitation severity, informs device sizing from mitral annular diameter measurements, and determines the leaflet lengths at the landing zone for device delivery. These findings are critical for clinical decision-making and proper device selection. During the procedure, TEE provides real-time visual guidance of device location, leaflet capture, device stability, and after-procedural assessment. This review will describe TEE imaging for MV edge-to-edge repair in dogs based on the experience gained in 130 dogs undergoing V-Clamp implantation. This is an evolving field that will progress with experience in this procedure across multiple institutions.