The short answer is, Yes.
Detailed answer is also yes : Read further please.
The MitraClip procedure, is designed to reduce mitral regurgitation (MR) by approximating the mitral valve leaflets, can alter the direction or nature of residual MR, including potentially converting a central MR jet into an eccentric one . This possiblity depends on the pre-procedural anatomy, the placement of the clips, and the resulting changes in mitral valve dynamics.
Central MR in ischemic dilated cardiomyopathy (DCM) typically arises from functional MR, where symmetric annular dilation and leaflet tethering (due to LV remodeling) create a central regurgitant jet through a malcoapted valve. The MitraClip works by grasping the anterior and posterior leaflets, usually at the A2-P2 segments, to create a double-orifice valve, reducing the regurgitant orifice area. When successful, this diminishes the overall MR volume, often preserving the jet’s central nature if residual MR remains.
However, if the clip placement is asymmetri or if multiple clips are positioned unevenly, the geometry of the mitral valve can shift. This could redirect the residual regurgitant flow. For example, if the clip is placed more toward the medial or lateral commissure, or if it disproportionately restricts one leaflet’s motion (e.g., excessive tethering of the posterior leaflet), the remaining gap might produce an eccentric jet directed toward the opposite side of the left atrium.
Echocardiographic studies post-MitraClip occasionally report changes in jet direction. While the primary goal is MR reduction, not all procedures eliminate regurgitation entirely, and residual MR jets can appear eccentric depending on how the leaflets coapt after clipping. For instance, if the clip reduces central coaptation but leaves a smaller, off-center orifice, the jet might angle toward the atrial wall, resembling eccentric MR seen in organic valve disease (e.g., prolapse). This isn’t necessarily a conversion from central to eccentric in the classical sense but rather a modification of the residual flow pattern.
Clinical data doesn’t frequently highlight this as a major issue. In trials like COAPT and MITRA-FR, the focus is on MR severity reduction rather than jet direction, and eccentric jets aren’t systematically reported as a post-procedural phenomenon. However, case studies and operator experiences suggest that jet redirection can occur, particularly with suboptimal clip positioning or in complex anatomies.
Implication of new onset eccentric jet
1.Eccentric jet directed towards one of the pulmonary veins can cause unpredictable postural dyspnea.
2.Eccentric jets are difficult to quantify the exact post clip ERV.
3.Can Interfere with favorable remodelling of LA
4.Might Increase IE risk
Final message
Mitra-clip is an innovative catheter-based MR jet interrupter. However, it is not surprising this device could convert a central MR into an eccentric MR, considering the fact that it tampers with mitral valve orifice morphology almost blindly. Adding more complexity is that, the clip brings one more “Neo-regurgitation orifice”. Mitra-clip still can be useful in very selected patients, where it regresses the MR significantly. But, experience tells us the importance of precise clip deployment guided by meticulous imaging and expertise.
Postamble and a follow up question
Can mitraclip convert an eccentric jet into a central one ?
It would be great if this is possible .The problem here is , it need too much precision and overcoming the uncertainity of the iatogenic second jet morphology.
Dr.S.Venkatesan MD 