title: [The value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation].
abstract: OBJECTIVE
  To investigate the value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation.
  
  
  METHODS
  From October 2013 to June 2014, 6 transcatheter mitral valve repair operations were performed in our hospital for symptomatic patients with severe functional mitral regurgitation (MR), transesophageal echocardiography was applied to guide the implantation of 2 pieces of MitraClip. Clinical data are retrospectively analyzed to evaluate implantation timing and approach of the 2nd piece of MitraClip, as well as the immediate effect of the interventional therapy.
  
  
  RESULTS
  After implantation of 1st piece of MitraClip, transesophageal echocardiography evidenced MR ≥ grade 2 with central regurgitation and immediate mitral average transvalvular pressure gradient < 3 mmHg (1 mmHg = 0.133 kPa) in these 6 patients and 2nd piece of MitraClip was implanted in these patients. After implantation of 2nd piece of MitraClip, it is observed via transesophageal echocardiography that mitral regurgitations were reduced by ≥ 2 grades for all 6 patients. For 3 patients, MR was reduced to grade 1. For the other 3 patients, MR is reduced to grade 2. Among the 3 patients whose MR was reduced to grade 2, 2 operations were stopped because immediate mitral average transvalvular pressure gradient equaled to 3 mmHg, and the rest 1 operation was stopped because MR was too diverse and not able to select proper position to implant the next MitraClip. All 6 operations are completed successfully.There were no myocardial infarction, death or complications requiring mitral valve surgery after the MitraClip procedure. There were also no MitraClip detachment, thrombus embolism, mitral valve apparatus injuries, mitral stenosis, pericardial tamponade post procedure.
  
  
  CONCLUSIONS
  Transesophageal echocardiography plays an important role to guide the implantation of 2 pieces of MitraClip in transcatheter mitral valve repair operation. Mitral average transvalvular pressure gradient and initial position of regurgitation after implantation of the previous MitraClip are critical determinants for decision making if the next piece of MitraClip can be implanted or not.
authors.affiliation: Department of Echocardiography,Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Pu
authors.forename: Xianbao
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Bao
authors.forename: Pintong
authors.initials: P
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.forename: Yan
authors.initials: Y
authors.lastname: Feng
authors.forename: Jianjing
authors.initials: J
authors.lastname: Lin
authors.forename: Xiangdong
authors.initials: X
authors.lastname: You
authors.affiliation: Email: wja @zju.edu.cn.
authors.forename: Jian'an
authors.initials: J
authors.lastname: Wang
mesh_terms: D017548:Echocardiography, Transesophageal; D006801:Humans; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies