MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai). The first-in-human study of ValveClamp has demonstrated its early feasibility and effectiveness for the treatment of patients with degenerative MR. Transesophageal echocardiography (TEE) is the only imaging modality required for intraoperative guidance of ValveClamp implantation. Successful implantation depends on accurate localization and orientation of the clamp and efficient intraoperative communication between the echocardiographer and the intervention team. Thus, the focus of this review is on elaborating how two-dimensional (2D) and three-dimensional (3D) TEE are used in clinical practice to guide ValveClamp implantation and it may facilitate the understanding of simplicity and safety of this novel procedure. We also describe the implementation of several novel advancements in 3D TEE imaging, which improve the confidence of image interpretation for intraoperative guidance and expedite implantation times.

中文翻译：

---

经食道超声心动图对心尖二尖瓣边缘到边缘修复的实时监测和逐步指导

MitraClip边缘到边缘（E2E）修复系统是当前治疗二尖瓣返流（MR）指南中推荐的唯一经导管设备。MitraClip的经皮股静脉经房间隔进入需要复杂的可操纵输送系统，因此可能在技术上很复杂，无法将夹子最佳地定位和展开到二尖瓣上。已经设计了一种经心尖的E2E修复方法，以使MR易于操作（ValveClamp系统，上海汉宇医疗技术有限公司，上海）。ValveClamp的首次人体研究证明了其在治疗退行性MR患者中的早期可行性和有效性。经食道超声心动图（TEE）是ValveClamp植入术中指导所需的唯一成像方式。成功的植入取决于夹具的精确定位和方向以及超声心动图医师和介入团队之间有效的术中交流。因此，本综述的重点是阐述如何在临床实践中使用二维（2D）和三维（3D）TEE指导ValveClamp植入，这可能有助于理解这种新颖手术的简单性和安全性。我们还描述了3D TEE成像中一些新颖进展的实现，这些进展提高了术中指导的图像解释的信心并加快了植入时间。本文的重点是阐述如何在临床实践中使用二维（2D）和三维（3D）TEE指导ValveClamp植入，它可能有助于理解这种新颖手术的简便性和安全性。我们还描述了3D TEE成像中一些新颖进展的实现，这些进展提高了术中指导的图像解释的信心并加快了植入时间。本文的重点是阐述如何在临床实践中使用二维（2D）和三维（3D）TEE指导ValveClamp植入，它可能有助于理解这种新颖手术的简便性和安全性。我们还描述了3D TEE成像中一些新颖进展的实现，这些进展提高了术中指导的图像解释的信心并加快了植入时间。