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Advances in echocardiography: insights into the mitral valve and implications for surgical and percutaneous repair

F Maffessanti, G Tamborini, L Fusini, M Stevanella, M Sotaquira, E Caiani & M Pepi

Imaging the mitral valve apparatus ▪ In presence of severe mitral regurgitation, early surgery preserves long-term left ventricular function and imaging-based assessment of the mitral valve (MV) is essential to adopt the best surgical strategy. ▪ Percutaneous MV repair requires the clear delineation of intracardiac anatomy and the mechanism of mitral regurgitation, and this can only be achieved using echocardiography. New echocardiographic modalities ▪ 3D echocardiography allows visualization of the MV in an easy way and from multiple planes of the complex structures. ▪ Both experienced and less trained operators benefit from the use of 3D compared with traditional 2D echocardiography. ▪ 3D transesophageal echocardiography is highly accurate in the identification of both simple and complex cases of MV prolapse when compared with surgical inspection. Implications for MV surgery and MV percutaneous repair ▪ 3D echocardiography allows the assessment of the complexity of MV lesions, facilitating the surgical planning. ▪ 3D echocardiography is the ideal technique to evaluate the effect of MV repair on the morphology and function of MV annulus, leaflets and papillary muscles and their interaction with the aortic valve. ▪ Echocardiography plays a role in each phase of the percutaneous MV repair procedure, including patient selection, the delivering and positioning of the device, and follow-up evaluation. ▪ 3D imaging is fundamental for patient selection and prediction of procedural effectiveness.