Edited by

Ron Waksman, MD, Director of Clinical Research and Advanced Education, MedStar Cardiovascular Research Network, Cleveland Clinic, Washington, DC, USA.

Toby Rogers, MD, PhD, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.

List of Contributors xvii Introduction-The Mitral Book xxiii 1 The Pathology of Mitral Valve Disease 1Maria E. Romero, Sho Torii, and Renu Virmani 1.1 Introduction 1 1.2 General Anatomy of the Mitral Valve 1 1.2.1 Mitral Annulus 1 1.2.2 Leaflets 3 1.2.3 Chordae Tendineae and Papillary Muscles 5 1.2.4 Papillary Muscles and Left Ventricle 5 1.3 Pathology of Mitral Valve 5 1.3.1 Mitral Valve Stenosis 5 1.3.2 Aging Changes and Mitral Annulus Calcification (MAC) 6 1.3.3 Acute Mitral Regurgitation 8 1.3.4 Chronic Mitral Regurgitation 8 1.3.5 Degenerative MR; Myxomatous Degeneration of the Mitral Valve 8 1.3.6 Functional MR 10 References 11 2 The Importance of Minimally Invasive Approaches for Mitral Valve Repair 15Bobby Yanagawa and Niv Ad 2.1 Introduction to Minimally Invasive Mitral Valve Surgery 15 2.2 The Importance of MICS MVS 16 2.3 Patient Selection 17 2.4 Surgical Setup-Fibrillating Heart MVS 18 2.5 Alternatives for Cannulation 19 2.6 Alternatives to Myocardial Protection 19 2.7 Mitral Valve Repair 20 2.8 Outcomes 20 2.9 Initiating Minimally Invasive Mitral Valve Repair Program 21 2.10 Conclusion 22 References 22 3 When to Intervene-Should Surgical Guidelines Apply to Transcatheter Techniques in Treating Mitral
Regurgitation? 25Samir Kapadia, Rishi Puri, Kinjal Banerjee, and Lars G. Svensson 3.1 Introduction 25 3.2 Primary MR 25 3.2.1 Current Guideline Recommendations 25 3.2.2 Transcatheter Therapies-New Guideline Applications? 26 3.3 Secondary MR 29 3.3.1 Current Guideline Recommendations 29 3.4 Conclusions 31 References 32 4 Transcatheter Mitral Valve Therapies: A Three-Dimensional Echocardiographic View 35Shmuel Schwartzenberg, Chaim Yosefy, and Alexander Sagie 4.1 Introduction 35 4.1.1 Mitral Valve Anatomy 35 4.1.2 Mitral Valve Structure and Function 35 4.1.3 Mitral Regurgitation Severity 36 4.1.4 Diagnosis of MR Severity: Proximal Isovelocity Surface Area Method 36 4.1.5 Diagnosis of MR Severity: Vena Contracta Method 37 4.1.6 Primary and Secondary MR 37 4.1.7 Mitral Regurgitation and Cardiovascular Death and Morbidity 38 4.1.8 Screening for MitraClip Suitability 40 4.1.9 MitraClip Procedure Guidance 41 4.1.10 Transseptal Puncture 41 4.1.11 MitraClip Delivery Guidance 42 4.1.12 Adequacy of MitraClip Implantation Assessment 43 4.1.13 Other Technologies 45 4.2 Conclusions 45 References 45 5 CMR Assessment of Mitral Regurgitation 51Daniel Knight and Vivek Muthurangu 5.1 Introduction 51 5.2 Pulse Sequences Used in CMR 52 5.2.1 Cine Imaging 52 5.2.2 Phase Contrast Imaging 52 5.3 Assessment of MR Severity 52 5.3.1 Qualitative Assessment 52 5.3.2 Quantitative Assessment 55 5.3.3 Technical Considerations for the Quantitative Assessment of MR by CMR 56 5.4 Identification of MR Etiology 57 5.4.1 Primary MR 57 5.4.2 Secondary MR 57 5.5 The Role of CMR Assessment of MR in Clinical Practice 58 5.6 Conclusions 58 References 58 6 CT Planning for TMVR and Predicting LVOT Obstruction 63Dee Dee Wang, Mayra Guerrero, Brian O'Neill, Pedro A. Villablanca Spinetto, James Lee, Tiberio Frisoli, Marvin Eng, and William O'Neill 6.1 Introduction 63 6.2 History of Imaging for Mitral Valve Disease 63 6.2.1 TAVR CT Planning 63 6.2.2 Surgical and Transcatheter Mitral Interventions 63 6.3 Concept of Aortic and Mitral Valve Technology Development 64 6.4 Basics of CT Imaging Acquisition 66 6.5 Definition of Mitral Valve and TMVR device Landing Zone 66 6.6 Definition of LVOT 66 6.7 CT Methods for Neo-LVOT prediction modeling 67 6.8 CT Validation of Neo-LVOT Prediction Modeling Post-TMVR 68 6.9 Correlation Between Pre- and Post-TMVR CT Neo-LVOT Prediction Modeling 69 6.10 What Else Has CT Planning for TMVR Taught Us? 70 Acknowledgments 72 References 72 7 General Principles and State-of-the-Art Echocardiographic Evaluation of the Mitral Valve 75Federico M. Asch and Diego Medvedofsky 7.1 Introduction 75 7.2 Mechanism and Etiology of Chronic MR 75 7.2.1 Transthoracic Echocardiography 76 7.2.1.1 Assessment of MR Severity 76 7.2.2 Qualitative Assessment 76 7.2.2.1 Color Flow Doppler 76 7.3 Continuous Wave (CW) Density Jet 79 7.3.1 Semi-Quantitative Assessment 79 7.3.1.1 VC Width 79 7.4 Pulmonary Vein Flow/Mitral Inflow 79 7.4.1 Quantitative Assessment 80 7.5 Selection of Best Candidates for Interventions of the Mitral Valve 82 7.5.1 Echocardiographic Criteria of COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) Trial 84 References 84 8 Intraprocedural Echocardiography for MitraClip 87Philip Haines and Sumbal A. Janjua 8.1 Introduction 87 8.2 Pre-Procedure Evaluation 88 8.3 Importance of the Baseline Study - TEE 88 8.4 The Transseptal Puncture 95 8.5 Guiding MitraClip System to Mitral Valve 98 8.6 Intraprocedural Guidance of Clip within Mitral Valve and Leaflets 102 8.7 Post-Clip-Deployment Assessment of Mitral Valve Function 103 8.8 Assessment of Complications and Iatrogenic ASD 105 References 112 9 Intraprocedural Echocardiography for Transcatheter Mitral Valve Replacement 115Patrick T. Gleason, John C. Lisko, and Stamatios Lerakis 9.1 Introduction 115 9.2 Baseline Mitral Valve Assessment 115 9.3 Access to the Left Atrium, Left Ventricle, and Mitral Valve 116 9.4 Predeployment and Deployment Monitoring 118 9.5 Postdeployment Evaluation 120 References 122 10 Transcatheter Repair: MitraClip for Degenerative Mitral Regurgitation 125Ted Feldman 10.1 Surgery for Degenerative Mitral Regurgitation 125 10.2 Evidence Base for MitraClip 125 10.3 Challenges for the MitraClip Procedure 130 10.4 Evaluation of MitraClip for Less than Prohibitive-Risk DMR Patients 131 10.5 Future Directions for MitraClip and Alternative Approaches for Leaflet Repair 133 10.6 Summary 135 References 136 11 MitraClip(TM) for Secondary Mitral Regurgitation 139Brian J. Forrestal and Toby Rogers 11.1 Introduction 139 [...]opean and US Clinical Practice Guidelines 139 11.3 The MitraClip System 140 11.4 MitraClip Preprocedural Planning 140 11.5 Surgical Outcomes Data 140 11.6 The COAPT and MITRA-FR Trials 141 11.7 Summary and Conclusions 144 References 144 12 The Edwards PASCAL Transcatheter Valve Repair System 147Mirjam Winkel, Stephan Windecker, and Fabien Praz 12.1 Introduction 147 12.2 The Edwards PASCAL(TM) Transcatheter Valve Repair System 147 12.3 Implantation Procedure 148 12.4 Compassionate-Use and Early Feasibility Data 150 12.5 Future Developments 151 References 152 13 The Development of a Novel Percutaneous Treatment for Secondary Mitral Regurgitation-The Carillon® Mitral Contour System® 153Steven L. Goldberg 13.1 Introduction 153 13.2 REDUCE-FMR 157 13.3 The CARILLON Trial 160 13.4 Summary 161 References 161 14 A Fully Percutaneous Mitral Ring: The Cardioband System 163Antonio Mangieri, Enrico Poletti, and Azeem Latib 14.1 Introduction 163 14.2 Mitral Annulus Anatomy 163 14.3 Pathophysiological Role of the Mitral Annulus in Mitral Regurgitation 164 14.3.1 Mitral Annulus in FMR 164 14.3.2 Mitral Annulus in DMR 164 14.4 Surgical Annuloplasty in Mitral Regurgitation 164 14.5 The Cardioband System: Description of the Device 165 14.6 Procedural Planning 165 14.7 Clinical Studies 168 14.8 Possible Complications Related to the Implantation of Cardioband 170 14.9 Recurrence of Mitral Regurgitation Following Cardioband Implantation 171 14.10 Cardioband in Combination with Other Devices 172 14.11 Conclusions 173 References 173 15 Transcatheter Mitral Cerclage Annuloplasty 175Christopher Bruce, June-Hong Kim, Toby Rogers, and Robert J. Lederman 15.1 Introduction 175 15.2 Cerclage Anatomy and Function 175 15.3 Limitations of Coronary Sinus Annuloplasty 176 15.4 Cerclage Annuloplasty Device 177 15.5 The Cerclage Procedure 177 15.6 Preclinical Experiments 178 15.7 Initial Human Experience 178 15.8 Future Directions 180 15.9 Summary 182 Competing Interests 183 References 183 16 The Transapical Off-Pump Mitral Valve Repair with the NeoChord Implantation (TOP-MINI) 185Stefan Bertog, Laura Vaskelyte, Nalan Schnelle, Iris Grunwald, Ilona Hofmann, Sameer Gafoor, Markus Reinartz, Predrag Matic, Bojan Jovanovic, Kolja Sievert, Michèle Jaqueline Lembens, and Horst Sievert 16.1 Introduction 185 16.2 Technology 185 16.3 Patient Selection 186 16.4 Procedure 186 16.5 Echocardiographic Guidance 191 16.6 Examples 191 16.6.1 Ideal Anatomy 191 16.6.2 Acceptable Anatomy 191 16.6.3 Challenging Anatomy 192 16.6.4 Data 192 16.7 Conclusion 194 References 195 17 AltaValve(TM)-A Transcatheter Mitral Valve Regurgitation Treatment Technology 197Katherine Kumar, PhD and Saravana Kumar, PhD 17.1 Clinical Need 197 17.2 Device Description 198 17.2.1 Principle of Operation 198 17.2.2 Device Construction 199 17.2.2.1 Stent 200 17.2.2.2 Stent Cap 200 17.2.2.3 Tissue Valve 200 17.2.2.4 Fabric Skirts and Sutures 200 17.2.3 Delivery Systems 200 17.3 Anatomical Imaging and Sizing 202 17.4 Preclinical and Clinical Experience 203 17.4.1 Animal Studies 203 17.5 Human Clinical Experience 204 17.6 Summary 205 References 206 18 The ARTO Transcatheter Mitral Valve Repair System 209Andrejs Erglis, Inga Narbute, Agnese Strenge, and Samantha E. Greene 18.1 Device Description 209 18.2 Procedural Details 209 18.3 Clinical Experience with the ARTO System 212 18.4 Unique Features of the ARTO System 216 References 216 19 Transcatheter Mitral Annuloplasty: The Millipede Device 219Jason H. Rogers and Steven F. Bolling 19.1 Background 219 19.2 The Millipede Device 219 19.3 Millipede Implantation Procedure 220 19.4 Surgical Millipede Implants 220 19.5 Millipede Clinical Results 222 19.6 Clinical Implications 223 19.7 Summary 226 Author Disclosures 226 References 226 20 Transapical and Transseptal Access for Transcatheter Mitral Valve Replacement: Techniques and Devices 227James Edelman and Vinod H. Thourani 20.1 Introduction 227 20.2 Transapical Approach 227 20.2.1 Technique 228 20.2.2 Devices in Active Clinical Trial Phase 230 20.2.2.1 Tendyne 230 20.2.2.2 Intrepid 230 20.2.2.3 CardiAQ 231 20.2.2.4 TIARA 231 20.2.2.5 HighLife 231 20.3...