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The mitral and tricuspid valves

EuroEcho-Imaging 2017

The second session of the “Course on multimodality imaging in the cath lab: become an expert” was held on Wednesday morning and focused on the mitral and tricuspid valves.

Dr. Pedro Carrilho (Lisbon, Portugal) addressed the evaluation of mitral valve regurgitation (MR) prior to percutaneous intervention. Besides the need for correct quantification using a multiparametric approach, he highlighted the need for the assessment of repair feasibility based on the mechanism of the regurgitation and the morphological characteristics of the valve apparatus.

The second talk was given by Dr. José Ribeiro (VN Gaia, Portugal) and focused on intraprocedure guidance during clip implantation. Transesophageal echocardiography (TEE) is still the most useful imaging modality in this setting; the author covered the main stages, the appropriate imaging planes with 2D TEE and 3D TEE and what to look at in each of these, to ensure the safety and success of the procedure. The potential role of intracardiac echocardiography (particularly 3D ICE) for guiding intervention in the future was the final topic of this talk.

Dr. Marisa Trabulo (Lisboa, Portugal) covered the issue of imaging in the follow-up. The prognostic impact of MR after clip implantation was clearly shown. However, she also stressed the challenges of the echocardiographic quantification of MR after intervention since all of the usual parameters have several limitations in this scenario, highlighting the need for multimodality including TTE, TEE and cardiac magnetic resonance to assess mitral regurgitation, mitral valve area as well as left ventricular volumes and function.

The last presentation was given by Dr. Alberto Pozzoli (Zurich, Switzerland). He gave a glimpse of what the future may bring regarding intervention on the mitral and tricuspid valves – leaflet repair, annuloplasty devices, transcatheter prosthesis, etc. Promising data (although limited by small numbers) from the current experience with these devices was shown. The need for a careful selection of the best candidates for these therapies was also stressed.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.