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Transoesophageal echocardiography-based computational simulation of the mitral valve for MitraClip placement.

Introduction Patients with severe functional and/or organic mitral regurgitation (MR) deemed unfit for traditional surgical mitral valve (MV) repair or MV replacement may be eligible for percutaneous edge-to-edge repair with the MitraClip® system (Abbott Vascular Structural Heart, Menlo Park, CA, USA)1. Procedural challenges such as optimal clip location placement, and the ideal number of clips to be placed are met using trial and error and are susceptible to procedural inefficacy resulting in residual MR or mitral stenosis. In this study we present a novel computer-based imaging software (FEops, Ghent, Belgium), which allows the creation of a patient-specific three-dimensional reconstruction of the MV. Using preprocedural and post-procedural transoesophageal echocardiography (TOE) images of two patients, we demonstrate an accurate model, which shows valve anatomy across the cardiac cycle, including mitral valve regurgitation. Using this software, future MitraClip procedures may be preceded by a virtual analysis of the MV, which will allow a careful assessment of the feasibility of repair, ideal clip location, and number of clips to be placed.