Key result
3D echocardiography identifies absent lateral A1-P1 coaptation as the MitraClip target site in severe MR.
Case Report (n=1)
3D echocardiography with quantification software is useful for planning MitraClip intervention in complex organic mitral regurgitation.
Supports detailed pre-procedural 3D echo assessment in complex mitral regurgitation; leaves open impact on procedural outcomes.
An 81-year-old male was referred for evaluation of symptomatic severe mitral regurgitation with New York Heart Association (NYHA) class III–IV symptoms. Pre-procedural three-dimensional (3D) echocardiography showed complex Barlow’s disease with bi-leaflet prolapse of all segments and severe mitral regurgitation at lateral A1–P1 level (green arrow), as seen on corresponding colour-Doppler images at four-chamber and bicommissural view (white cross-hair; Supplementary material online, Video S1, left panels) (PanelA). The mitral valve quantification (MVQ) software (Qlab, Philips Medical Systems, version 9.0) was applied to construct a 3D mitral model, confirming diffuse prolapse (red colour) most prominent laterally (green arrow). (PanelB) It enabled to calculate the prolapsing volume of the leaflet segments and the coaptation area as the difference between total and atrial exposed leaflet area, represented as the grey zone of the mitral model shown from the ventricular perspective. The regurgitation originated from absent lateral A1–P1 coaptation (yellow arrow), identified as the target site for intervention. (PanelC)
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Debonnaire et al. (2016) conducted a case report in symptomatic severe mitral regurgitation (n=1). Three-dimensional echocardiography was evaluated. Three-dimensional echocardiography successfully identified absent lateral A1-P1 coaptation as the target site for MitraClip intervention in an 81-year-old male with severe mitral regurgitation.
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