Recently, the 3rd Session of the "Yu Jun Wei Ban, Apex Precision Intervention" Transapical TEER Ultrasound Practical Training Camp, hosted by HanYu Medical, was successfully held in Chengdu, Sichuan Province. As the southwest station of this series of events, the meeting continued to focus on the image guidance and practical operation of transapical transcatheter edge-to-edge repair (TA-TEER) for mitral valve. The event was honored to invite Professor Dong Lili, an ultrasound expert from Zhongshan Hospital Affiliated to Fudan University, and Professor Li Chao, a cardiac surgery expert from Yongchuan Hospital Affiliated to Chongqing Medical University to share their experiences respectively on the ultrasound and surgical operation aspects of transapical TEER. It attracted the participation of many clinical experts and physicians from the southwest region.

Academic Focus · Theory First

The morning courses focused on theory and experience sharing. Professor Li Chao from the Department of Thoracic and Cardiovascular Surgery, Yongchuan Hospital Affiliated to Chongqing Medical University, introduced a complex transapical TEER surgery recently performed on an elderly high-risk patient from the perspective of a cardiac surgeon. He detailed the patient's condition assessment, preoperative preparation, key intraoperative operations, and team collaboration, and also shared the postoperative follow-up results. Through this comprehensive case analysis, the participants gained an intuitive understanding of the complete treatment process for complex cases. The patient is currently recovering well and has been able to go out and engage in moderate activities.

Subsequently, Professor Dong Lili from Zhongshan Hospital Affiliated to Fudan University delivered a presentation titled Intraoperative Ultrasound Views and Mitral Valve Anatomical Variation Identification in TA-TEER, sharing key points and insights on ultrasound application in transapical TEER. Based on a large number of intraoperative images and complex cases, Professor Dong systematically organized the key points of patient selection, preoperative measurement and strategy formulation, as well as intraoperative guidance and imaging coordination techniques. Focusing on the "three core links" of ultrasound application in TA-TEER—preoperative assessment, intraoperative guidance, and intraoperative evaluation—she proposed an operable imaging workflow. 

She emphasized the "2+1" view strategy: taking the commissural view as the main working view (for identifying A1–A3 and P1–P3 segments), combining it with the mitral valve long-axis view, and supplemented by the 3D left atrial view (surgical perspective). At the same time, she highlighted that when the left ventricle is significantly enlarged (LVEDD > 70 mm), it is difficult to obtain ideal ultrasound views.

Regarding mitral valve anatomical variations, Professor Dong systematically sorted out the following:

For Degenerative Mitral Regurgitation (DMR): Prolapse, flail leaflet, Barlow's disease, mitral annular disjunction (MAD), rheumatic lesions, and the differentiation between cleft and indentation;

For Functional Mitral Regurgitation (FMR): Distinguishing between ventricular functional mitral regurgitation (VFMR, caused by papillary muscle displacement/chordal traction) and atrial functional mitral regurgitation (AFMR, caused by atrioventricular annular dilatation, "pseudo-prolapse" of the anterior leaflet), and emphasizing the geometric differences between the two.

She pointed out that DMR and FMR often present in a mixed form, especially in elderly patients or those with a long disease course. It is necessary to analyze the etiologies layer by layer and comprehensively judge the suitability for TEER based on factors such as leaflet thickness, calcification range, valve orifice area, and coaptation length. As she summarized: "Every jet of regurgitation has its cause, which should be identified and valued."

Discussion Session

In the subsequent "Cardiac Surgery Sharing" interactive session, on-site experts and participants conducted lively discussions on the surgical significance of MAD, the feasibility of TEER for calcified leaflets, and the key points of writing imaging reports, creating a strong academic atmosphere.

Practical Training · Skill Enhancement

In the afternoon, the training moved on to practical operation. Under the guidance of the tutor team, participants were divided into groups to take turns on stage and simulate the completion of transapical TEER operations, applying the ultrasound view knowledge and anatomical identification skills learned in the morning to practical scenarios. This practical session significantly improved the participants' hands-on ability and their mastery of the entire surgical process, laying a foundation for future clinical application. 

Certificate Awarding · Group Photo

After a day of intensive and rewarding learning, the training camp concluded successfully with the certificate awarding ceremony and a group photo. The participants not only gained improved skills but also expanded their communication and cooperation with peers across the country.

Future Outlook

As an important stop of the "Yu Jun Wei Ban, Apex Precision Intervention" series of training camps, the successful holding of the southwest station has further promoted the standardized development of transapical TEER technology in the region. In the future, HanYu Medical will continue to carry out a series of training programs across the country, work together with experts and scholars, continuously explore and improve the training system for domestic transapical TEER technology, and contribute to the overall improvement of the treatment level of structural heart diseases in China.