Impact of Leaflet Tethering on Residual Regurgitation in Patients With Degenerative Mitral Disease After Interventional Edge-to-Edge Repair

Figures

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  Figure 1. The main steps of ValveClamp implantation. (A) The clamp is delivered and opened within the left atrium (LA). (B) The clamp is adjusted to the appropriate position; the rear clamp is placed just under the leaflets, and the front clamp remains within the LA. (C) The front clamp is pulled back to capture the leaflets, and then the closed ring is moved forward to cover the ventricular end of the clamp arms, approximating the mitral valve (MV) leaflets and strengthening the clamp. (D) The clamp is released.

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  Figure 2. Changes in mitral valve (MV) anatomic parameters in the residual MR 2+ and residual ≤ 1+ groups: AP diameter (A), prolapse height (B), tenting volume (C), and annular area (D). (E) The annular area increased in parallel with the tenting volume increase in the residual MR 2+ group, but not in the residual ≤1+ group. ns, no significance. *P < 0.05; **P < 0.001.

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  Figure 3. (A) Receiver operating characteristic curves of parameters in predicting residual MR 2+. (B) Kaplan–Meier estimates freedom from recurrent 3+ MR or MV surgery. TVi, tenting volume index; THi, tenting height index; AAi, annular area index; AUC, area under curve.

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  Figure 4. A typical case with P2 prolapse/flail and secondary bileaflet tethering. (A) Left: MV modeling from MVN analysis vividly demonstrating a prolapsing P2 scallop (shaded yellow) and tented scallops (shaded blue). Right: MV modeling showing the residual tenting volume (shaded blue) and residual regurgitant orifice (A1 and A2). (B) MV commissural view and long-axis view derived by multiplanar reconstruction (MPR) from real-time 3D dataset showing preoperative P2 prolapse/flail and leaflet tethering (white arrow). Orange arrow indicates the flail/coaptation gap. (C,D) MPR images derived from 3D Color Doppler dataset showing leaflet tethering with residual regurgitant jets after ValveClamp implantation. The total vena contracta area (VCA) was as follows: VCAA1 + VCAA2 = 0.16 cm2 + 0.12 cm2 = 0.28 cm2. Left: color compress images; Middle: color Doppler images; Right: VCA measurements. Asterisks indicate the implanted clamp.