title: Anatomical challenges for transcatheter mitral valve intervention.
abstract: Following the success of transcatheter aortic and pulmonary valve implantation, there is a large interest in transcatheter mitral valve interventions to treat severe mitral regurgitation (MR). With the exception for the MitraClip™ (Abbott, Abbott Park, IL, USA) edge-to-edge leaflet plication system, most of these transcatheter mitral valve interventions are still in their early clinical or preclinical development phase. Challenges arising from the complex anatomy of the mitral valve and the interplay of the mitral apparatus with the left ventricle (LV) have contributed to a more difficult development process and mixed clinical results with these novel technologies. This review aims to discuss the several anatomical aspects and challenges related to transcatheter mitral valve intervention--the relevant anatomy will be reviewed in relation to specific requirements for device design and procedural aspects of transcatheter mitral valve interventions. To date, experience with these novel therapeutic modalities are still limited and resolution of many challenges are pending. Future studies have to evaluate for whom the transcatheter approach is a feasible and preferred treatment and which patients will benefit from either transcatheter mitral valve repair or replacement. Nevertheless, technological developments are anticipated to drive the transcatheter approach forward into a clinically feasible alternative to surgery for selected patients with severe MR.
authors.affiliation: Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark - lars.soendergaard.01@regionh.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: De Backer
authors.forename: Ngai H V
authors.initials: NH
authors.lastname: Luk
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
mesh_terms: D059925:Anatomic Landmarks; D006328:Cardiac Catheterization / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors