Transcatheter edge-to-edge repair

MitraClip for secondary (functional) MR · four-chamber cutaway
Four-chamber cutaway of the heart during mitral edge-to-edge repair The heart is opened to show the right and left atria and ventricles. A steerable guide catheter rises from the inferior vena cava into the right atrium, crosses the interatrial septum at the fossa ovalis and enters the left atrium. The clip delivery system is steered down to the mitral valve, where tethering of both leaflets by a dilated left ventricle prevents coaptation and permits a central regurgitant jet into the left atrium. The clip crosses into the left ventricle, grasps both leaflets between its arms and grippers and closes, and the jet shrinks. RA LA RV LV Aorta PA SVC IVC Pulmonary veins Tricuspid valve Tetheredleaflets Displacedpapillarymuscles Dilated LV · dashed: normal size Fossa ovalis 24 Fr guide fromthe femoral vein Fossa ovalis LA LV Clip delivery system LA LV

Surgeon's view from the left atrium

The mitral valve seen from the left atrium, aortic valve at the top, showing the regurgitant orifice and the clip Ao LAA IAS A1 A2 A3 P1 P2 P3 AL PM

Procedure

Stage 0 of 6

Baseline

EROA0.44 cm²
RVol65 mL
MR gradeSevere 4+

Illustrative model, not patient data. The orifice is drawn and computed as an ellipse (EROA = π/4 × length × width); regurgitant volume = EROA × an MR VTI of 140 cm; grades follow the four-grade MR table (US anchors: severe 4+ at EROA ≥ 0.40 cm² or RVol ≥ 60 mL; ESC 2025 may call ventricular secondary MR severe from ≥ 0.30 cm² or ≥ 45 mL when the orifice is elliptical or forward flow is low). Tenting height is measured on the drawing, from the annular plane to the coaptation point in systole. Proportions follow published dimensions: clip arms 4 mm wide and ~10 mm long, 24 Fr guide, transseptal puncture 3.5–4 cm above the annulus.