Key result
ICE-guided M-TEER reduces severe medial P3 flail MR to mild with a ~2 mm Hg gradient.
Why the study?
Published experience using 3-dimensional intracardiac echocardiography to guide mitral transcatheter edge-to-edge repair when transesophageal echocardiography is contraindicated remains limited and has predominantly involved central A2/P2 pathology.
Does 2D/3D intracardiac echocardiography (ICE) guidance enable safe and effective mitral transcatheter edge-to-edge repair (M-TEER) in a patient with severe degenerative mitral regurgitation from a medial P3 flail and prior esophagectomy?
Case Report (n=1)
Does 2D/3D intracardiac echocardiography (ICE) guidance enable safe and effective mitral transcatheter edge-to-edge repair (M-TEER) in a patient with severe degenerative mitral regurgitation from a medial P3 flail and prior esophagectomy?
Comprehensive 2D and 3D intracardiac echocardiography can enable safe and effective mitral transcatheter edge-to-edge repair for challenging medial A3-P3 pathology when transesophageal echocardiography is contraindicated.
May enable TEER when TEE is contraindicated; leaves open whether ICE guidance extends to routine complex medial leaflet cases.
Background Transesophageal echocardiography (TEE) is the standard imaging modality for mitral transcatheter edge-to-edge repair (M-TEER). When TEE is contraindicated, 3-dimensional intracardiac echocardiography (ICE) may provide an alternative; however, published experience remains limited and has predominantly involved central A2/P2 pathology. Case Summary A 69-year-old man with severe degenerative MR from a medial P3 flail and prior esophagectomy underwent M-TEER exclusively under 2D/3D ICE guidance. ICE facilitated transseptal puncture, guide positioning, clip orientation, leaflet grasping, and assessment of residual MR and transmitral gradient. One MitraClip XTW was implanted at A3/P3, reducing MR from severe to mild with a mean gradient of 2 mm Hg. He was discharged the following day without complications. Discussion This case demonstrates that comprehensive ICE guidance can extend M-TEER beyond the commonly reported A2/P2 position to challenging medial anatomy. Take-Home Message Comprehensive 2D and 3D ICE can enable safe and effective M-TEER of challenging A3-P3 pathology when TEE is contraindicated or not feasible.
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Zeid et al. (2026) conducted a case report in Severe degenerative mitral regurgitation from a medial P3 flail with prior esophagectomy (n=1). 2D/3D intracardiac echocardiography (ICE)-guided mitral transcatheter edge-to-edge repair (M-TEER) with MitraClip XTW was evaluated on Mitral regurgitation reduction and post-procedural transmitral mean gradient. 2D/3D ICE-guided M-TEER with 1 MitraClip XTW at A3/P3 reduced medial P3 flail mitral regurgitation from severe to mild with a 2 mm Hg mean gradient.
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