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Chapter 46. An Overview of the MitraClip Procedure: Practical Considerations and Evidence Base

Which of the following is NOT a characteristic of the anterior leaflet?

A. It is broader than the posterior leaflet.

B. It is also known as the mural leaflet.

C. It comprises one-third of the annular circumference.

D. It shares a fibrous continuity with the left and noncoronary cusps of the aortic valve.

The correct answer is B

The valve is also known as the aortic leaflets, which share a continuity with the aortic valve (left and noncoronary cusps) that is often referred to the intervalvular fibrosa or aortic-mitral curtain. All the other answers are characteristics of the anterior leaflet.

The MitraClip is based off of what surgical technique?

A. Mitral valve annuloplasty

B. David’s technique

C. Feikes technique

D. Alfieri stitch

The correct answer is D

The Alfieri stitch is an edge-to-edge repair/plication. Percutaneous mitral annuloplasties are currently under investigation but use a different technique for valvular intervention. David’s technique is a surgical technique that preserves the anterior leaflets and its chordal attachments by excising a central trapezoidal segment of the anterior leaflet and resuspending the residual leaflet to the anterior annulus. In the Feikes technique, the anterior leaflet is incised in the midline and the incision is extended sideways, then the 2 segments of the anterior leaflet are turned backward and sutured to the posterior mitral annulus.

How can you minimize risk of chordal entanglement with the MitraClip?

A. By using multiple clips

B. By making the majority of positioning adjustments after the clip is advanced into the ventricle

C. By making the majority of positioning adjustments when the clip is within the valve leaflets

D. By ensuring coaxial advancement of the clip prior to moving into the left ventricle

The correct answer is D

Multiple clips and positional changes when in the left ventricle (LV) increase the risk of entanglement. The manipulation of the valve at the level of the valve does not increase entanglement into the chords; however, it is not advisable. The best way to minimize risk of entanglement is to perform the majority of the positioning adjustments when the clip is in atria, prior to ...

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