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Melillo et al. Mini-invasive Surg 2020;4:81 I http://dx.doi.org/10.20517/2574-1225.2020.83 Page 15 of 17

strict anatomical criteria (isolated prolapsed/flail of P2 with a central regurgitant jet); (2) absence of
significant annular dilatation; (3) adequate length of the posterior leaflet compared to the antero-posterior
MA diameter (ideally > 21%); (4) adequate coaptation leaflet reserve; (5) evaluation of MAC because this
may cause shadowing and impaired visualization of the device; and (6) determination of the transapical
access [50-52] [Figure 11].

Transthoracic echocardiography is frequently used to decide the optimal intercostal space and location for
the mini-thoracotomy. MDCT permits the visualization of the anatomical relation between apex and chest
wall and the definition of a trajectory for the device.

CONCLUSION
Transcatheter mitral valve interventions provide a new spectrum of therapeutic options for high-risk
patients. Accurate patient selection and choice of the treatment strategy, either leaflet or annular approach,
or combined, goes through a comprehensive preprocedural multimodality imaging evaluation aimed at
the characterization of the functional anatomy of MR and its interplay with left ventricular geometry and
function.

DECLARATIONS
Authors’ contributions
Proof writing: Melillo F, Boccellino A
Proof revision: Ingallina G, Ancona F, Capogrosso C, Napolano A, Stella S, Agricola E
Conception and design: Melillo F, Agricola E

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Del Forno B, De Bonis M, Agricola E, et al. Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options. Nat Rev
Cardiol 2020:1-21.
2. Zekry SB, Nagueh SF, Little SH, et al. Comparative accuracy of two- and three-dimensional transthoracic and transesophageal
echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: initial observations. J Am Soc
Echocardiogr 2011;24:1079-85.
3. Faletra FF, Leo LA, Paiocchi VL, et al. Anatomy of mitral annulus insights from non-invasive imaging techniques. Eur Heart J
Cardiovasc Imaging 2019;20:843-57.
4. Heo R, Son JW, Hartaigh BÓ, et al. Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic