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Catheter-based repair of a leaking mitral valve: scenes from a procedure day
The steps of mitral valve repair performed without opening the chest, using a catheter advanced through the vein in the groin, with photographs from a procedure day.
Catheter-based repair of a leaking mitral valve (transcatheter edge-to-edge repair, TEER) is done without opening the chest. The heart is reached with a catheter advanced through the vein in the groin. Here we describe how the procedure goes, with photographs from a procedure day in October 2026.
A procedure day in the catheter laboratory, October 2026.
What is mitral regurgitation?
The mitral valve lies on the left side of the heart, between the left atrium and the left ventricle, and has two leaflets. If the valve does not close fully, some blood leaks backward into the left atrium with every heartbeat. This is called mitral regurgitation, or a leaking mitral valve. When the leak is severe, the heart has to work harder; breathlessness, tiring easily, palpitations and swollen legs may occur.
The procedure step by step
Anaesthesia and imaging
The procedure is usually done under general anaesthesia. An echo probe passed through the gullet (TOE) shows the valve live throughout the procedure. The catheter's progress inside the heart is also followed on X-ray.
Access
A thin sheath is placed in the vein in the groin (the femoral vein). Through it, the catheter is advanced to the right atrium of the heart.
Access and preparing the catheter.
Crossing between the atria
The catheter is passed through the thin wall that separates the two atria and reaches the left atrium (transseptal crossing).
Placing the clip
The clip is steered to the mitral valve and opened. It grasps the front and back leaflets where the leak is and holds them together. The valve now works with two openings.
The clip system is steered with small adjustments on its stabiliser.
Check and closure
Echocardiography is used to check how much the leak has lessened and whether the valve has become narrowed. If needed, the clip is repositioned or a second clip is added. When the result is found appropriate, the clip is released, the catheter is removed and the access site is closed.
A team effort
Whether the valve is suitable for repair is decided by a heart team of cardiologists and cardiac surgeons. On the day of the procedure, the interventional cardiology, anaesthesia and echocardiography teams work together.
The team after the procedure.
Who is it considered for?
- Patients with severe mitral regurgitation who have ongoing symptoms such as breathlessness or tiring easily
- Patients for whom open-heart surgery carries a high risk, or who are not suitable for surgery
- Patients whose leak is caused by a weakened heart muscle and whose symptoms continue despite appropriate medical treatment
The valve must be found suitable for repair on echocardiography. The aim is to reduce the leak; how much it lessens depends on the structure of the valve. Your doctor will explain the possible benefits and risks for you in detail, based on your own situation.
Medical content reviewed and approved by Prof. Dr. Barış Kılıçaslan. Last updated: 28 October 2026. Editor: Baran Zeydan (info@clinixcrm.app).