Echocardiographic Assessment of a Double-Orifice Mitral Valve: Tips and Tricks

The edge-to-edge (EE) technique is also called “double-orefice mitral valve repair”, is an established techniqueof mitral valve repair, in wich the suture of the two leaflts’ free edge creates a double orefice mitral valve.Mitral valve reconstruction is currently the standard treatment for degenerative disease, functional MR and some selected cases of infective endocarditis and rheumatic disease.Focusing on the EE technique, we must considered for a good echocardiographic assessment of a Double-orefice mitral valve tips and tricks, three main settings: 1. The preoperative setting; 2. The intraoperative setting; 3. The postoperative setting.In the preoperative setting, 2D or 3D transesophageal echocardiography can help to understand the mechanism of mitral disease and predict the feasibility and durability of the EE repair.In the intraoperative setting, if residual mitral regurgitation (MR) is present, it is very important to understand the mechanismand the real grade of the residual regurgitation, normalizing the intraoperative hemodynamic conditions and use some maneuvers of load’s changes.Our echocardiography tips and tricks can help to avoid possible misdiagnosis.Moreover, in the current era of percutaneus procedure, the echocardiography plays an important role also in the selection of the patient, intraprocedural monitoring and early and late follow-ups of the MitraClipsystem.The echocardiography assessment of a double orefice mitral valve repair requires skill, knowledge, and experience; the evolution of 3D echocardiographic technique has improved our ability to detect anatomical lesions andto assess the mechanisms of EE failure.