Video 1
Echocardiograms, including 3D TEEs, of atrioventricular valve before and after TEER developed for percutaneous treatment of mitral regurgitation; also see at https://vimeo.com/1200546282. MR: mitral regurgitation; TEEs: transesophageal echocardiograms; TEER: transcatheter edge-to-edge repair
Table 1
Lesion-specific considerations for transcatheter edge-to-edge repair (TEER) in adult congenital heart disease. AVVR: atrioventricular valvular regurgitation; AVSD/CAVC: atrioventricular septal defect/complete atrioventricular canal; CCTA: cardiac CT angiography; ccTGA: congenitally corrected transposition; CMR: cardiac MR; d-TGA: dextro-transposition; ICE: intracardiac echocardiography; LA: left atrium; MCS: mechanical circulatory support; mMV/mRV/mTV: morphologic mitral/right-ventricular/tricuspid valve; MR/TR: mitral/tricuspid regurgitation; PA: pulmonary artery; PLE: protein-losing enteropathy; PVR: pulmonary vascular resistance; RF: radiofrequency; TEE: transesophageal echocardiography
| SUBSTRATE/TARGET VALVE | MECHANISM OF REGURGITATION | ACCESS & IMAGING | DEVICE & TECHNIQUE |
|---|---|---|---|
| ccTGA — systemic TR Systemic morphologic tricuspid valve (mTV) | Annular dilation - mRV dilation under systemic afterload Ebstein-like dysplasia in 20-30% | Transseptal into morphologic LA Trajectory orthogonal to usual mitral axis 3D TEE with commissural mapping | Wide-arm clips at anteroseptal gap |
| d-TGA, atrial switch — systemic TR (transbaffle TEER) Systemic mTV and mRV | Progressive systemic mRV failure with TR Moderate to severe TR ~24% to ~64% at death/transplant/MCS | Transbaffle puncture CCTA + 3D ICE Close access with septal occluder | Mirror-image valve orientation Check baffle pressures + gradient |
| d-TGA, atrial switch — subpulmonary MR Subpulmonary mMV | Functional MR from subpulmonary LV dysfunction Elevated PVR/PA pressure | Via pulmonary venous baffle limb No conventional transseptal needed Assess fixed vs post-capillary PVR | Target antero-rightward mMV Standard clip platforms |
| AVSD/CAVC Left “mitral” component of repaired common AV valve | Cleft malcoaptation, annular dilation Patch/suture dehiscence | Standard transseptal to left-sided valve Segmental 3D echo + simulation | Wide-arm clips for dilated annulus Multiple clips across cleft; preserve orifice |
| Single-ventricle Fontan Systemic AV valve(s) of single ventricle | AVVR poorly tolerated in passive circulation Drives PLE, plastic bronchitis, Fontan failure | Conduit puncture or fenestration dilation CMR + full hemodynamics Caution if Fontan pressure > 18–20 mm Hg | Often multiple clips Avoid ↑PVR/↓preload; sparing pacing |