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September 10, 2026Journal of Cardiovascular ImagingOpen Access

Intraprocedural echo demands temporal leaflet-level frameworks for M-TEER and spatial annular-level frameworks for TMVR.

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Why the study?

Current consensus documents provide modality-level guidance without explicitly formalizing the divergent imaging requirements inherent to mechanistically distinct transcatheter mitral valve interventions.

Design

State-of-the-art review

Key result

Intraprocedural echocardiographic guidance for transcatheter mitral valve interventions requires distinct imaging paradigms: a leaflet-level, temporally driven framework for M-TEER and an annular-level, spatially driven framework for TMVR.

Authors

SBStan A. BenjaminsMVMartijn G. H. VrijkorteLTLeo Timmers

Discussion

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Overview

May inform procedure-specific echocardiographic strategies in TMVI; extends consensus documents but leaves open prospective validation.

Key Points

  • Synthesize evidence on intraprocedural echocardiographic guidance for transcatheter mitral valve interventions and formalize procedure-specific imaging workflows for repair and replacement techniques.
  • State-of-the-art review synthesizing evidence on intraprocedural echocardiographic guidance modalities for transcatheter edge-to-edge repair and transcatheter mitral valve replacement.
  • Evaluated 2D and 3D transesophageal echocardiography, real-time multiplanar reconstruction, echocardiography-fluoroscopy fusion imaging, 3D intracardiac echocardiography, and artificial intelligence-assisted decision-support tools.
  • Identified two distinct imaging frameworks: a leaflet-level, temporally driven paradigm for edge-to-edge repair and an annular-level, spatially driven paradigm for transcatheter replacement.
  • Characterized real-time multiplanar reconstruction as the central geometric bridge linking temporal precision to 3D spatial clarity, with artificial intelligence enhancing spatial consistency.
  • Demonstrated that effective intraprocedural guidance requires transitioning from modality-centric tools toward integrated, platform-based multimodal workflows aligned with procedural objectives.

Structured PICO

P
Population
Patients undergoing transcatheter mitral valve interventions (TMVIs), including mitral transcatheter edge-to-edge repair (M-TEER) and transcatheter mitral valve replacement (TMVR), for mitral regurgitation.
I
Intervention
Intraprocedural echocardiographic guidance, including 2D and 3D transesophageal echocardiography (TEE), real-time multiplanar reconstruction (MPR), echocardiography-fluoroscopy fusion imaging, 3D intracardiac echocardiography (ICE), and artificial intelligence (AI)-assisted decision-support tools.

This review provides a structured framework for intraprocedural echocardiographic guidance in TMVIs, distinguishing the specific imaging needs of M-TEER versus TMVR and highlighting the role of multimodal integration.

Limitations

  • Current consensus documents provide modality-level guidance without explicitly formalizing the divergent imaging requirements of M-TEER and TMVR.
  • AI-assisted tools have limited prospective comparative data and vendor-specific implementations.
  • Echocardiography-fluoroscopy fusion is susceptible to co-registration drift and requires recalibration.
  • 3D ICE has a limited field of view, is highly operator-dependent, and has predominantly feasibility-level evidence.

Cite This Study

Benjamins et al. (2026) conducted a review in Mitral regurgitation. Intraprocedural echocardiographic guidance was evaluated. Intraprocedural echocardiographic guidance for transcatheter mitral valve interventions requires distinct imaging paradigms: a leaflet-level, temporally driven framework for M-TEER and an annular-level, spatially driven framework for TMVR.

synapsesocial.com/papers/6aa27afb58559d80afc73e2chttps://doi.org/10.1186/s44348-026-00092-7
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