Key result
Mirrored 4-chamber TOE imaging in M-TEER is linked to ~31% longer transseptal puncture time.
Why the study?
Clinical transoesophageal echocardiography imaging remains restricted to the 0-180° range despite matrix-array probes technically allowing full 360° multiplane rotation, a limitation that may impair procedural efficiency during transseptal puncture in mitral transcatheter edge-to-edge repair.
Does the requirement for mirrored four-chamber (>140°) transoesophageal echocardiography imaging prolong transseptal puncture duration compared with standard imaging in patients undergoing mitral transcatheter edge-to-edge repair?
Observational (n=211)
Does the requirement for mirrored four-chamber (>140°) transoesophageal echocardiography imaging prolong transseptal puncture duration compared with standard imaging in patients undergoing mitral transcatheter edge-to-edge repair?
Mirrored four-chamber TOE imaging (>140°) is required in 14.2% of M-TEER procedures and is associated with significantly longer transseptal puncture times, highlighting the potential utility of unrestricted 360° multiplane rotation.
Mirrored 4Ch imaging was associated with longer TSP in M-TEER; hypothesis-generating for unrestricted 360° multiplane rotation.
Background Contemporary matrix-array transoesophageal echocardiography (TOE) probes technically allow full 360° multiplane rotation; however, clinical imaging remains restricted to the conventional 0–180° range. This limitation may impair procedural efficiency during transseptal puncture (TSP) in mitral transcatheter edge-to-edge repair (M-TEER). Purpose To assess the frequency of mirrored four-chamber (4Ch) imaging (>140°) during TSP in M-TEER and its association with procedural timing. A secondary objective was to evaluate the feasibility of unrestricted 360° multiplane imaging in a simulation environment. Methods We performed a retrospective analysis of 211 consecutive patients undergoing M-TEER. TOE recordings were reviewed to identify cases requiring mirrored 4Ch imaging during TSP. TSP time was defined as the interval from right atrial instrumentation to septal puncture. Additionally, a TOE simulator was modified to allow unrestricted 360° multiplane rotation, enabling negative-angle imaging (<0°). Results Mirrored 4Ch imaging was required in 30 cases (14.2%). Median TSP time was 394 [291–560] seconds. Procedures requiring mirrored imaging were associated with significantly longer TSP duration compared with standard imaging (502 [326–745] vs. 383 [280–514] seconds; p = 0.039). Unrestricted 360° multiplane rotation was technically feasible in a simulator, enabling acquisition of mirrored and negative-angle views. Conclusion Mirrored 4Ch imaging during TSP is a frequent and clinically relevant phenomenon associated with prolonged transseptal access in M-TEER. Enabling optional unrestricted 360° multiplane rotation may facilitate more efficient transseptal guidance during structural heart interventions.
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Stapor et al. (2026) conducted an observational in Mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER) (n=211). Mirrored four-chamber (4Ch) TOE imaging (>140°) vs. Standard TOE imaging was evaluated on Transseptal puncture (TSP) duration (seconds) (p=0.039). Mirrored 4-chamber TOE imaging (>140°) was required in 14.2% of M-TEER cases and was associated with longer transseptal puncture time vs standard imaging (502 vs 383 seconds; p=0.039).
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