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Updated: Apr 23, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
CT-Guided Preprocedural Assessment of TEER in Mitral Prolapse: When Calcification Limits TEE
Boren Tan1, Xinping Lin1, Qifeng Zhu2
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China; Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, China; Transvascular Implantation Devices Research Institute, Hangzhou, Zhejiang, China.
Background:
Transcatheter edge-to-edge repair (TEER) relies on accurate preprocedural imaging. Severe mitral leaflet calcification may impair transesophageal echocardiographic assessment and complicate procedural planning.
Case Summary:
A 74-year-old woman presented with a 6-month history of exertional dyspnea and decreased exercise tolerance. Transthoracic echocardiography demonstrated mitral valve prolapse in A3 with severe mitral regurgitation leaflet calcification, left atrial enlargement, and a preserved left ventricular ejection fraction of 73.7%. Because of prohibitive surgical risk, TEER was recommended. Preprocedural transesophageal echocardiography was limited by leaflet calcification, preventing accurate leaflet length and grasping zone measurement. Cardiac computed tomography (CT) was therefore performed and used for detailed anatomical assessment and procedural planning. TEER was successfully performed with significant reduction in mitral regurgitation and symptomatic improvement.
Discussion:
This case report illustrates the complementary role of cardiac CT in TEER planning when echocardiography is suboptimal because of heavy calcification.
Take-Home Message:
Cardiac CT enables precise anatomical characterization in challenging TEER cases.
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