Mitral valve training › Guides › Edge-to-edge repair (TEER clip)

Mitral TEER (edge-to-edge clip) on echo: residual MR and gradient

What to look for: A bright clip joining the tips; a double orifice in PSAX; the gradient.

Key findings

• After transcatheter edge-to-edge repair, parasternal short axis at the leaflet tips shows the clip(s) joining the leaflet edges and a double (or multiple) orifice; note each clip’s position (A1/P1 to A3/P3).
• Residual jets come from the edges of the clips.
• Look for single-leaflet device attachment (the clip holds only one leaflet and the regurgitation returns) and for the small atrial shunt left by the transseptal puncture.

Grading after TEER

• Residual MR: flow convergence is constrained by the clip, so PISA is not valid. Grade each jet by its vena contracta and count the jets, with the CW density and the pulmonary vein flow.
• A mean gradient ≥5 mmHg at a normal heart rate suggests stenosis; the pressure half-time is not valid after a clip.

Pitfalls

• Several small jets add up: count them and grade them together.

In the simulator every case varies the anatomy, the jets and the measurements: watch the lesion in Learn, then grade new cases in Practice and compare your answer with the exact one.

Related

Surgical repair (annuloplasty ring) · Bioprosthetic mitral valve · Mechanical mitral valve

Educational simulation to use under the supervision of a clinical tutor — not for clinical use.