Impact of the posterior mitral leaflet anatomical variation on the
efficacy of ValveClamp using three-dimensional transesophageal
Background Multiple studies illustrated that mitral valve (MV)
leaflet presented variations, and there is little known about the
posterior mitral leaflet (PML) anatomical variation affecting residual
MR in interventional mitral valve edge-to-edge repair (TEER) with the
ValveClamp system in patients with degenerative mitral regurgitation
(DMR) using three-dimensional transesophageal echocardiography (3D TEE).
Method Fifty-five DMR patients treated with TEER were included
and performed 3D TEE pre- and post-procedure immediately. 3D TEE images
were proceeded to characterize the posterior mitral leaflet anatomy and
investigate the relationship between variations and residual mitral
regurgitation (MR). Results Variations in PML were found in 16
patients (32%) of this series, including 3 cases (6%) of one scallop,
8 cases (16%) of two scallops, and 5 cases (10%) of four scallops.
Residual MR ≥ 2+ were found in 3 patients with variant PML and 8
patients with classical PML post procedures, while other patients were
all < 2+. The Chi-square test results showed no correlation
between residual MR and PML variants (18.8% vs. 23.5, ᵪ
2 = 0, p = 0.988). Of the 5 patients with 4 scallops,
3 had poor clinical outcomes. Two patients were converted to surgical
mitral valve repair and one died 1 month after implantation.
Conclusions 3D TEE provides a novel and non-invasive method to
characterize and classify PML variations. Variations in PML are
relatively common and not associated with residual MR 2+.