The thesis focuses on gaining new understanding about functional mitral regurgitation and evaluating the impact of percutaneous transcatheter mitral valve therapies. Chapter 1 provides an overview of the transcatheter mitral repair technologies and the key points in patient selection and procedural guidance. Chapter 2 uses 3D transesophageal echocardiography to evaluate leaflet remodeling in functional mitral regurgitation and finds significant remodeling and decreased coaptation area in patients with worse functional mitral regurgitation. Chapter 3 evaluates changes in mitral valve geometry in the presence of significant aortic regurgitation and finds that severe mitral regurgitation can arise when adaptive mechanisms of the mitral valve fail. Chapter 4 evaluates the relationship between global and regional myocardial function and the recurrence of functional mitral regurgitation in patients with ischemic mitral regurgitation who underwent surgery. Chapter 5 investigates the eligibility for transcatheter mitral valve therapy in high surgical risk patients with mitral regurgitation recurrence after initial surgery. Chapter six evaluates the effects of the transatheter-based mitral valve edge-to-edge repair technique using the MitraClip device on mitral valve geometry in patients with functional mitral regurgitation. Transesophageal echocardiography is crucial for guiding implantation and assessing acute procedural success. The findings show that the technique directly affects mitral valve geometry by increasing the coaptation length and area of the mitral leaflets, leading to a larger contribution of the anterior mitral leaflet to coaptation.LUMC / Geneeskund
