Mitral regurgitation is one of the most prevalent valvular heart diseases in western countries. In the USA, the estimated prevalence of moderate and severe mitral regurgitation is 2–2.5 million adults.1 The decrease in the prevalence of rheumatic valve disease and increased life expectancy has led to a high prevalence of degenerative aetiology. As a consequence, the patients are older and present with concomitant comorbidities that increase the operative mortality and morbidity risks. This results in a denial or non-referral for surgery in almost 50% of patients with mitral valve regurgitation.2

In the last decade, several minimally invasive and transcatheter based valve repair techniques have been developed in order to provide a feasible alternative treatment to conventional valve surgery for patients with mitral regurgitation and high operative risk. The feasibility and safety of these procedures have been demonstrated in several trials. The procedural success relies on accurate pre-procedural evaluation of the patients who are candidates for these therapies and exact procedural guiding. Therefore, cardiac imaging may play a central role in this field.

Advances in imaging techniques, such as real-time three dimensional transoesophageal echocardiography (TOE), multidetector row computed tomography (MDCT), and MRI, provide detailed information on the mitral valve anatomy and its spatial relationships. Fluoroscopy remains the mainstay imaging technique to guide percutaneous mitral valve interventions. However, the poor soft tissue contrast resolution of this technique does not allow proper visualisation of the intracardiac structures. Therefore, the use of complementary imaging tools such as echocardiography may provide more accurate procedural guiding. Ongoing research aims to integrate fluoroscopy with the aforementioned three dimensional imaging techniques in order to provide more accurate and sophisticated analysis of cardiac anatomy during percutaneous interventions.

This article reviews the current status of the transcatheter mitral valve procedures with special emphasis on the role of multimodality …