Diagnostic Tools: Transesophageal Echocardiography for Mitral Valve

LEARNING OBJECTIVES

• Transesophageal echocardiography is the imaging modality of choice to evaluate the mitral valve complex prior to transcatheter interventions

• A comprehensive assessment of the mitral valve for interventions includes defining the morphology, etiology, and severity of disease

• Quantifying mitral regurgitation severity at baseline, intra­procedurally, and at follow-up requires a multi-parametric and multi-modality (two- [2D] and three-dimensional [3D]) echocardiographic assessment.

INTRODUCTION

With the addition of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) to the current American College of Cardiology/American Heart Association Guideline for the Management of Patients With Valvular Heart Disease transcatheter mitral interventions have become an essential treatment option for patients with both primary and secondary MR. Transesophageal echocardiography (TEE) is the imaging modality of choice for determining anatomic suitability for ^, and procedural guidance. ^, The role of three-dimensional (3D) TEE for defining complex mitral anatomical details and MR severity has become indisputable. A number of other transcatheter devices are also in development or clinical trials. The basic TEE imaging protocol prior to intervention will be discussed as well as the anatomic considerations for mitral valve (MV) transcatheter therapies.

GENERAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING PROTOCOL FOR THE MITRAL VALVE