3D Intracardiac Echocardiography in Mitral Transcatheter Edge-to-Edge Repair

Figure 1. Barium Esophagram The image demonstrates a massive hiatus hernia above the diaphragm (white arrow) compressing the distal esophagus (yellow arrow).

Figure 2. Baseline Transesophageal Echocardiography (A) The 2-dimensional X-plane view showing the tethered mitral valve. (B) Color Doppler imaging demonstrating central regurgitation. (C) Multiplanar reconstruction. (D) Mitral regurgitation (MR) velocity time integral (VTI) and effective regurgitant orifice area (EROA) by volumetric methods.

Figure 3. Posterior Cleft The 3-dimensional “en-face” transesophageal echocardiographic view of the mitral valve demonstrates a large posterior cleft (white arrows) between P1 and P2. LA = left atrial; LV = left ventricular.

Figure 4. Transseptal Puncture (A) Transesophageal view of transseptal puncture, hiatus hernia in view (arrows). (B) Fluoroscopy of intracardiac echocardiography catheter traversing the interatrial septum adjacent to the transseptal wire.

Figure 5. Leaflet Insertion Intracardiac echocardiography demonstrating clear visualization of leaflets and clip arms.

Figure 6. Postdeployment Intracardiac Echocardiography (A) Scanning across clip device. (B) 3D view to assess the tissue bridge of the clip. (C) Adequate leaflet length within device confirmed (yellow circles) (D) Color Doppler imaging showing mild mitral regurgitation. HVR = high volume rate.