CT-Guided Preprocedural Assessment of TEER in Mitral Prolapse: When Calcification Limits TEE

BACKGROUND: Transcatheter edge-to-edge repair (TEER) relies on accurate preprocedural imaging. Severe mitral leaflet calcification may impair transesophageal echocardiographic assessment and complicate procedural planning. CASE SUMMARY: A 74-year-old female presented with a 6-month history of exertional dyspnea and decreased exercise tolerance. Transthoracic echocardiography demonstrated mitral valve prolapse in A3 with severe mitral regurgitation (MR), leaflet calcification, left atrial enlargement, and preserved left ventricular ejection fraction of 73.7%. Owing to prohibitive surgical risk, TEER was recommended. Preprocedural transesophageal echocardiography (TEE) was limited by leaflet calcification, preventing accurate leaflet length and grasping zone measurement. Cardiac computed tomography (CT) was therefore performed and used for detailed anatomical assessment and procedural planning. TEER was successfully performed with significant reduction in mitral regurgitation and symptomatic improvement. DISCUSSION: This case illustrates the complementary role of cardiac CT in TEER planning when echocardiography is suboptimal due to heavy calcification. TAKE-HOME MESSAGES: Cardiac CT enables precise anatomical characterization in challenging TEER cases.