The Role of Echocardiography in Mitral Valve Repair

Echocardiography is a versatile diagnostic technology integral to the assessment and treatment of mitral regurgitation (MR). MR is broadly classified as primary—resulting from abnormalities of the MV leaflets or apparatus, or secondary—arising from left ventricular dysfunction and subsequent distortion of mitral architecture. While these entities have distinctly different outcomes and treatment strategies, the common therapeutic goal is to reduce MR and improve outcomes through medical management alone or MV repair. MV repair is performed surgically or percutaneously with echocardiography guidance. In this chapter we will comprehensively discuss the role of trans-thoracic (TTE) and trans-esophageal (TEE) 2D, 3D, and Doppler techniques to enhance procedural and patient outcomes by (1) performing an integrative assessment of the etiology, mechanism, severity, and hemodynamic impact of the MR, (2) predicting the feasibility and prognosis of MV repair, (3) directly guiding catheter placement, and (4) assessing for complications during or after MV repair.