2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis

Mitral regurgitation (MR) is the most prevalent form of valve disease, affecting about 10% of people over the age of 75 and associated with increased mortality [1,2]. Management is dependent on the cause, pathophysiology, and predicted treatment efficacy. While the historical gold standard for disease refractory to medical therapy is valve repair or replacement, over the last decade several transcatheter strategies have emerged, providing less invasive alternative options to elderly and frail patients at high risk for open heart surgery. Recently, transcatheter mitral valve replacement (TMVR) using a valve-in-native valve approach has become a well-established alternative option for patients with severe primary and secondary MR considered high or prohibitive surgical risk [3]. Mitral leaflets cannot be assessed by fluoroscopy, so procedural success relies on echocardiographic guidance by transesophageal echocardiogram (TEE) [4]. Echocardiographers must be able to provide a comprehensive assessment immediately prior to, during and after implantation in order to define not only success, but also problematic anatomy and inadequate deployment.