The value of three-dimensional color Doppler trans-esophageal echocardiography in predicting the number of MitraClip devices needed during the procedure

PURPOSE: During MitraClip procedure, one or more clips might be needed to effectively reduce the mitral regurgitation (MR). Three-dimensional vena-contracta (3D-VC) assessed by color Doppler three-dimensional trans-esophageal echocardiography (3D-TEE) was proven to be well correlated with MR severity. However, its role in predicting the number of MitraClip devices needed during the procedure was not fully determined. Aim of this study is to assess the predictive value of 3D-VC area & length in determining the number of clips needed during the procedure. METHODS: 3D-TEE with color Doppler was performed in 20 patients ( age: 68.9 ± 2.5 years; 65% males; with functional severe/moderately severe MR) who underwent successful MitraClip procedure (reduction of MR to <2+). Manual tracing and measurement of the 3D-VC area (3D-VCA) as well as the 3D-VC length (3D-VCL) was done. These values were compared between patients who received 1 clip (n = 4) and ≥ 2 clips (n = 16). RESULTS: Patients who received ≥ 2 clips had larger 3D-VC area compared to patients who received 1 clip (0.39 ± 0.23 cm(2) vs. 0.13 ± 0.03 cm(2), p = 0.04, t = 2.22) . Patients who received ≥ 2 clips had bigger 3D-VC length compared to patients who received 1 clip (1.14 ± 0.33 cm vs. p = 0.005, t = 3.25 ). A cut-off values of 0.20 cm(2) & 1 cm for the VCA & VCL respectively, are suggestive that the patient will most likely require more than one MitraClip device to treat his mitral regurgitation. CONCLUSIONS: The 3D-VCA & 3D-VCA using 3D TEE is helpful indetermining the number of MitraClip devices needed during the procedure in functional mitral regurgitation.