Guidance of the MitraClip® procedure by 2D and 3D imaging.

Percutaneous edge-to-edge repair using MitraClip® (Abbott Laboratories, Abbott Park, IL, USA) can be used to treat mitral regurgitation. However, real-time echocardiographic guidance is vital; and use of 3D transoesophageal echocardiography to guide the procedure has improved reproducibility, reliability and safety. This review describes the MitraClip® device - which is composed of a steerable guide catheter (SGC) and a Clip Delivery System (CDS) - and the MitraClip® procedure. The procedure consists of six steps: (1) transseptal approach and puncture; (2) introduction of the SGC into the left atrium; (3) navigation with the CDS into the left atrium to place the MitraClip® above the mitral valve; (4) crossing the valve and advancing the CDS into the left ventricle; (5) grasping the leaflets and assessment of the quality of the grasping; and (6) final mitral regurgitation assessment. This review also describes which imaging techniques are applicable to each stage of the procedure; and contains examples of the various images obtained during these steps.