1 of 18

Transcatheter Mitral Valve Replacement (TMVR) �and �Transcatheter Mitral Valve Edge-to-Edge Repair (mTEER)

The Leaflet Lounge

Kristina Mack MSN-ED, BSN, RN, CCRN-CMC, CV-BC

September 2026

Click to edit Master title style

1

2 of 18

DISCLAIMER��The information in this presentation is for educational use only.

Click to edit Master title style

2

3 of 18

Mitral Valve Review

3

Click to edit Master title style

3

4 of 18

The mitral valve (also called the left atrioventricular valve) is located between the left atrium and left ventricle. The valve allows oxygen-rich blood to flow from the left atrium and into the left ventricle.

​

The mitral valve is a bicuspid valve meaning it has two flaps (leaflets) – the anterior (aortic) leaflet and the posterior (mural) leaflet. These leaflets are thin and made of fibrous tissue. The leaflets are supported by the chordae tendineae attached to the papillary muscle of the left ventricle.

​

The leaflets also attach to the mitral annulus which is a fibrous and saddle-shaped or D-shaped junction that connects the tissue of the left atrium to the tissue of the left ventricle. It surrounds the valve orifice and helps to maintain valve shape and integrity.

​

Common mitral valve problems include regurgitation, stenosis, and prolapse.

​

4

Click to edit Master title style

4

5 of 18

Common Mitral Valve Problems

Regurgitation, Stenosis, and Prolapse

5

Click to edit Master title style

5

6 of 18

Mitral Valve Regurgitation

  • Leaky valve where the valves do not close tightly causing a backflow of blood problem
  • Can be primary (degenerative or organic) or secondary (functional or ischemic mitral regurgitation) depending on the cause
  • Possible causes:
    • Mitral valve prolapse
    • Rheumatic fever
    • Myocardial infarction (ischemic mitral regurgitation) and coronary artery disease
    • Congenital heart defects
    • Dilated and hypertrophic cardiomyopathy
    • Endocarditis
    • Radiation therapy
    • Damaged chordae tendineae
    • Arrhythmias

​

​

6

Carpentier classification:

​

  • Type I
    • Normal leaflet motion
    • Typically caused by annular dilation or leaflet perforation
    • Centrally directed regurgitant jet

​

  • Type II
    • Excessive leaflet motion caused by papillary muscle rupture, chordal rupture, redundant chordae
    • Eccentric jet directed away from the prolapsing leaflet

​

  • Type III
    • Restricted leaflet motion
      • III a
        • Restriction occurs during diastole and systole
        • Commonly due to rheumatic heart disease
      • III b
        • Restriction occurs only during systole due to papillary muscle dysfunction or left ventricular remodeling
        • Observed in patients with ischemic and dilated cardiomyopathy-associated mitral regurgitation
  • Often mild and happens slowly (chronic), but it can also develop quickly (acute mitral valve regurgitation)

​

  • Other names include mitral insufficiency and mitral incompetence

​

Click to edit Master title style

6

7 of 18

Mitral Valve Stenosis

  • Narrowed/ stiffened valve
  • Forward blood flow problem
  • Divided into 4 clinical stages and graded by the severity
  • Causes:
    • Rheumatic fever
    • Calcium deposits
    • Radiation therapy
    • Congenital heart defects
    • Autoimmune disease
  • Complications:
    • Atrial fibrillation
    • Blood clots
    • Stroke
    • Pulmonary hypertension
    • Right-sided heart failure

​

​

7

Stage A:

At risk; no structural changes

Stage B:

Progressive; mild to moderate

Stage C:

Asymptomatic Severe

Stage D:

Symptomatic Severe

​

​

​

Grade 1:

Near normal leaflet thickness of 4-5 mm

Grade 2:

Normal mid leaflets with considerable marginal thickening (5-8 mm)

Grade 3:

Thickening extending through the entire leaflet measuring 5-8 mm

Grade 4:

Considerable thickening of entire leaflet tissue measuring more than 8-10 mm

Click to edit Master title style

7

8 of 18

Mitral Valve Prolapse (MVP)

  • Leaflets are floppy and bulge backward
  • Can cause mitral regurgitation
  • Can be primary, secondary, or mixed process
  • Characterized by two histopathological patterns:
    • Myxomatous degeneration
      • Progressive, non-inflammatory connective tissue breakdown
    • Fibroelastic deficiency
      • Lack of connective tissue to support valve’s supporting cords
  • Conditions that increase the risk for MVP include connective tissue disorders, skeletal problems, some types of muscular dystrophy, and Grave’s disease
  • More common in men and patients with history of hypertension
  • Complications of MVP are rare, but severe cases causing complications are due to a backflow of blood.

​

8

  • Other names for Mitral Regurgitation:
    • Myxomatous mitral valve
    • Floppy valve syndrome
    • Click-murmur syndrome
    • Billowing mitral valve
    • Barlow’s syndrome
    • Balloon mitral valve

​

Click to edit Master title style

8

9 of 18

Mitral Valve Disease Signs and Symptoms

Mitral Valve Stenosis

  • Exertional dyspnea
  • Orthopnea
  • Palpitations
  • Peripheral edema
  • Pulmonary congestion
  • Arrhythmias (i.e. atrial fibrillation)
  • Hemoptysis
  • Chest pain/ discomfort
  • Dizziness
  • Syncope
  • Diastolic murmur heard at the apex in left lateral decubitus position

Mitral Valve Prolapse

  • Most patients have no symptoms
  • Palpitations
  • Fatigue
  • Exertional dyspnea/ exercise intolerance
  • Chest pain/ discomfort
  • Dizziness/ orthostatic symptoms
  • Pre-syncope/ syncope
  • Recurrent headaches
  • Anxiety
  • Mid-systolic click followed by late-systolic murmur

​

Mitral Valve Regurgitation

  • Dyspnea
  • Orthopnea
  • Palpitations
  • Peripheral edema
  • Fatigue
  • Arrhythmias (i.e. atrial fibrillation)
  • Chest pain/ tightness
  • Lightheadedness
  • Dizziness
  • Frequent nighttime urination

9

Click to edit Master title style

9

10 of 18

Mitral Valve Interventions

Repair, Replacement, and Transcatheter Methods

10

Click to edit Master title style

10

11 of 18

Mitral Valve Regurgitation Interventions

Medications:

  • Angiotensin-converting enzymes (ACE) and angiotensin II receptor blockers (ARBs)
  • Beta-blockers
  • Diuretics
  • Blood thinners

Surgical Interventions:

  • Surgical annuloplasty, leaflet repair, and/or chordal replacement
  • Surgical mitral valve replacement with mechanical or biological tissue valve
  • In primary MR, surgery is recommended for symptomatic chronic severe MR with EF >30%. However, in some patients mTEER by be considered due to eligibility criteria
  • Surgery is also indicated for asymptomatic with LV dysfunction

​

Minimally Invasive Interventions:

  • Transcatheter Edge-to-Edge Repair (mTEER)
  • Transcatheter Mitral Valve Replacement

11

Click to edit Master title style

11

12 of 18

Mitral Valve Stenosis Interventions

Medications:

  • Diuretics
  • Beta-blockers or calcium channel blockers
  • Anticoagulants
  • Antibiotics (if rheumatic fever caused the initial damage)

Surgical Interventions:

  • Surgical commissurotomy
  • Surgical mitral valve replacement with mechanical or bioprosthetic valve

Minimally Invasive Interventions:

  • Mitral balloon valvuloplasty
  • Valve-in-valve replacement
  • Valve-in-MAC (mitral annular calcification)
  • Percutaneous balloon commissurotomy

12

Click to edit Master title style

12

13 of 18

Mitral Valve Prolapse Interventions

13

Click to edit Master title style

13

14 of 18

Transcatheter Mitral Valve Replacement (TMVR)

Transcatheter mitral valve replacement is a minimally invasive procedure where a catheter is guided the right atrium via fluoroscopy and echocardiography guidance.

A trans-septal puncture is made to advance the catheter and device delivery system to the left atrium.

The device is then carefully positioned using fluoroscopy and echocardiography.

The current systems on the market are self-expanding and balloon-expandable. Once the new valve is deployed, the catheter is then removed.

14

Image from Mirage News

Click to edit Master title style

14

15 of 18

Transcatheter Mitral Valve Edge-to-Edge Repair (mTEER)

Transcatheter mitral valve edge-to-edge repair is a minimally invasive procedure where a catheter is guided the right atrium via fluoroscopy and echocardiography guidance.

A trans-septal puncture is made to advance the catheter and device delivery system to the left atrium.

The device is carefully positioned, and the “arms” of the clip are opened directly above the section of the valve that is leaking.

The clip is then pushed down, passing the leaflets, and into the left ventricle. When the clip is pulled back, leaflet grasping occurs trapping the edges and closing the clip’s arms.

Typically, one to three clips may be inserted dependent on deployment evaluation.

Once verified as sufficient, the clip is locked and released from the catheter.

15

Click to edit Master title style

15

16 of 18

Resources:

16

Alahmadi, M. H., Haleem, S. M., & Sharma, S. (2026, April 26). Mitral stenosis. StatPearls Publishing. Nih.gov. https://ww.ncbi.nlm.nih.gov/books/NBK430742

​

Cleveland Clinic. (2022). Mitral valve: Location, anatomy, and function. Cleveland Clinic. https://my.clevelandclinic.org/health/body/23244-mitral-valve

​

Cleveland Clinic. (2022, June 4). Mitral valve prolapse: Symptoms, diagnosis & treatments. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17241-mitral-valve-prolapse

​

Douedi S, Alahmadi MH. Mitral Regurgitation. [Updated 2026 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553135/

​

Harb A, Moriles KE, Sharma S. Mitral Valve Prolapse. [Updated 2026 Jun 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470288/

​

Mayo Clinic. (2019). Mitral valve repair and mitral valve replacement - mayo clinic. Mayoclinic.Org. https://www.mayoclinic.org/tests-procedures/mitral-valve-repair-mitral-valve-replacement/about/pac-20384958

​

Mayo Clinic. (2022). Mitral valve prolapse - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mitral-valve-prolapse/symptoms-causes/syc-20355446

​

Mayo Clinic. (2023, September 19). Mitral valve regurgitation - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/symptoms-causes/syc-20350178

​

Mayo Clinic. (2024, September 4). Mitral valve stenosis - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159

​

Metkus, T., Dugdale, D., & Conaway, B. (2026, January 27). Mitral valve prolapse: MedlinePlus medical encyclopedia. Medlineplus.Gov. https://medlineplus.gov/ency/article/000180.htm

​

​

Click to edit Master title style

16

17 of 18

Resources Continued:

Minimally invasive mitral valve repair | Cleveland Clinic. (2019). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17234-minimally-invasive-mitral-valve-repair

Mitral valve disease – diagnosis and treatment – mayo clinic. (2023, September 20). https://www.mayoclinic.org/disease-conditions/mitral-valve-disease/diagnosis-treatment/drc-20355112

Mitral valve prolapse | general surgery. (2025). Ucsf.Edu. https://generalsurgery.ucsf.edu/condition/mitral-valve-prolapse

Mitral valve regurgitation signs & symptoms | rush. (2025). Rush.Edu. https://www.rush.edu/conditions/mitral-valve-regurgitation

Mitral valve stenosis | Columbia surgery. (2025). Columbiasurgery.Org. https://columbiasurgery.org/conditions-and-treatments/mitral-stenosis

Pick, A., & McCarthy, P. (2026, February 26). Mitral regurgitation - symptoms, diagnosis & treatment. Heart-Valve-Surgery.Com. https://www.heart-valve-surgery.com/mitral-valve-regurgitation-symptoms-leaking.php

Transcatheter mitral valve repair & replacement (TEER and TMVR). (2026). Wellstarhealth. https://www.wellstar.org/medical-services/treatments-procedures/mitraclip

Transcatheter mitral valve replacement (TMVR). (n.d.). Cleveland Clinic. Retrieved September 18, 2026, from https://my.clevelandclinic.org/health/treatments/24200-transcatheter-mitral-valve-replacement-tmvr

What symptoms indicate the need for mitral valve replacement? (2023, March 6). Sri Ramakrishna Hospital. https://www.sriramakrishnahospital.com/blog/cardiology/what-symptoms-indicate-the-need-for-mitral-valve-replacement/

Yandrapalli S, Sharma S, Kaplan J. Minimally Invasive Mitral Valve Surgery. [Updated 2024 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567730/

​

17

Click to edit Master title style

17

18 of 18

Thank You!

Click to edit Master title style

18