Successful Transcatheter Mitral Edge-to-Edge Repair in Patient With Situs Inversus Due to Kartagener Syndrome

Figures

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  Visual Summary. Diagnostics and Management of Severe Functional Mitral Regurgitation in a Patient With Situs Inversus Due to Kartagener Syndrome 3D = 3-dimensional; M-TEER = mitral transcatheter edge-to-edge repair.

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  Figure 1. Chest Radiograph Posteroanterior chest radiograph demonstrating dextrocardia due to situs inversus. The image also shows an implanted cardiac resynchronization therapy device.

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  Figure 2. Standard Transesophageal Echocardiographic Views (A) Bicaval view, (B) aortic valve short-axis (base) view, (C) midesophageal 4-chamber view, and (D) transgastric short-axis view. Note the wider angulation in B and C, and a sharper angle in the bicaval view (A), consistent with mirror-image anatomy.

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  Figure 3. Mitral Valve Imaging in Situs Inversus (A) Multiplanar reconstruction of the mitral valve in a bicommissural view. The left ventricular outflow tract view is mirror-reversed, resulting in reversed anterior-posterior orientation. (B) A 3D reconstruction of the mitral valve. In the 3D reconstruction, with the aortic valve positioned at 12 o'clock, medial-lateral orientation is also reversed. The left atrial appendage (star) is seen on the right-hand side. 3D = 3-dimensional.

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  Figure 4. Intraprocedural Mitral Valve Repair Imaging (A to C) Three-dimensional transesophageal echocardiography and (D and E) fluoroscopy during transcatheter edge-to-edge repair: (A) Baseline image showing severe mitral regurgitation; (B and D) positioning and implantation of the first clip in the central segment, resulting in residual moderate regurgitation; and (C and E) implantation of the second clip, reducing regurgitation to mild in the lateral segment (P1 to A1) with a narrow vena contracta.