From the Guidelines
The acceptable flail gap for mitral clip placement is typically less than 10 mm, with optimal results generally seen when the flail gap is between 2-10 mm. For patients with a flail gap greater than 10 mm, the success rate of mitral clip procedures decreases significantly due to challenges in grasping the leaflets effectively 1. When evaluating candidates for mitral clip procedures, physicians should measure the flail gap using transesophageal echocardiography (TEE) from multiple views to ensure accurate assessment. The flail gap represents the distance between the atrial surface of the flailing mitral valve leaflet and the plane of the mitral valve annulus during systole. This measurement is crucial because excessive flail gaps can lead to procedural failure or suboptimal results due to residual mitral regurgitation. The anatomical limitation exists because the mitral clip device has finite arm length and grasping capacity, making it mechanically difficult to approximate widely separated leaflets. For patients with flail gaps exceeding 10 mm, alternative interventions such as surgical repair or replacement may be more appropriate treatment options.
Some key considerations when evaluating the flail gap include:
- The width of the flail leaflet area, which should be ≤15 mm 1
- The presence of significant calcification, clefts, or perforations, which can make the procedure more challenging or increase the risk of complications 1
- The mitral valve opening area, which should be ≥4 cm² 1
- The leaflet thickness, which should be ≤5 mm 1
It's essential to note that the guidelines and recommendations for mitral clip placement are continually evolving, and the decision to proceed with the procedure should be made on a case-by-case basis, taking into account the individual patient's anatomy, symptoms, and overall health status 1.
From the Research
Acceptable Flail Gap for Mitral Clip
- The acceptable flail gap for mitral clip is less than 10 mm, as indicated in the study 2.
- This specific measurement is part of the anatomic criteria for the indication of MitraClip in patients with severe degenerative or functional mitral regurgitation.
- Other anatomic criteria include a coaptation length of at least 2 mm and a coaptation depth of no more than 11 mm in functional MR, and a flail width of less than 15 mm in degenerative MR.
- These criteria highlight the importance of precise measurements in determining the suitability of the MitraClip procedure for patients with mitral regurgitation.
- There is no other information in the provided studies that contradicts or expands on the acceptable flail gap for mitral clip beyond the criteria outlined in 2.