16 September, 2026

MitraClip & TEER in India: Advanced Transcatheter Treatment for Mitral Regurgitation Dr. A. B. Gopalamurugan | Advanced Mitral Valve & Structural Heart Interventions

MitraClip and Transcatheter Edge-to-Edge Repair (TEER) are catheter-based treatments used to reduce severe mitral regurgitation in carefully selected patients without conventional open-heart mitral valve surgery.

In India, Dr. A. B. Gopalamurugan works extensively in advanced structural heart interventions, including transcatheter mitral valve therapies, MitraClip, TEER, TMVR and treatment of complex heart valve disease. His professional profile documents percutaneous mitral repair using MitraClip as part of his structural intervention practice.

For patients searching for:

MitraClip India
TEER India
MitraClip specialist in India
Transcatheter Edge-to-Edge Repair India
Mitral valve specialist India
MitraClip doctor India
Advanced mitral valve treatment India

the most important question is not simply whether MitraClip is available.

The real question is:

Is TEER the right treatment for this particular patient’s mitral valve disease?

That decision requires detailed imaging, understanding of the cause of mitral regurgitation, evaluation of heart function and surgical risk, and assessment by an experienced structural Heart Team.

What Is TEER?

TEER stands for Transcatheter Edge-to-Edge Repair.

It is a minimally invasive catheter-based technique used to repair a leaking mitral valve in appropriately selected patients.

The mitral valve sits between the left atrium and left ventricle.

Normally, the valve closes when the left ventricle contracts, allowing blood to move forward through the heart.

When the valve does not close properly, blood leaks backwards into the left atrium.

This is called mitral regurgitation, or MR.

Severe mitral regurgitation can contribute to:

breathlessness;
fatigue;
reduced exercise tolerance;
swelling of the legs;
recurrent heart-failure admissions; and
progressive deterioration in cardiac function.

With TEER, the mitral valve is approached through the vascular system rather than through a conventional surgical opening of the chest.

A specialised device is positioned across the leaking portion of the mitral valve and brings selected parts of the valve leaflets closer together.

The aim is to reduce mitral regurgitation while maintaining adequate blood flow through the valve.

What Is MitraClip?

MitraClip is one of the devices used to perform mitral TEER.

This distinction is useful:

TEER = the procedure

MitraClip = the device used to perform the repair

The device is delivered to the heart through a catheter, usually introduced through a vein in the groin.

The catheter is advanced to the right atrium and then guided across the atrial septum into the left atrium.

The MitraClip is positioned above the mitral valve and oriented toward the area responsible for the regurgitation.

The device then grasps selected portions of the anterior and posterior mitral valve leaflets.

This creates improved leaflet contact and can significantly reduce the amount of blood leaking backwards.

Depending on the anatomy, one clip may be sufficient, while some patients require two or more clips.

The objective is therefore not simply to implant a MitraClip.

A successful TEER strategy needs to achieve three things simultaneously:

Reduce the mitral leak.
Maintain an adequate mitral valve opening.
Avoid creating significant obstruction across the valve.

That balance makes procedural imaging and operator experience particularly important.

Who Is Suitable for MitraClip or TEER?

Not every patient with mitral regurgitation should undergo TEER.

In fact, patient selection is one of the most important determinants of a successful MitraClip procedure.

A specialist evaluation usually considers:

severity of mitral regurgitation;
cause of the valve leak;
severity of symptoms;
heart function;
previous heart surgery;
previous coronary procedures;
age and overall health;
surgical risk;
mitral leaflet anatomy;
degree of valve calcification;
size of the mitral valve opening;
pulmonary pressures;
response to medical therapy; and
other associated cardiac conditions.

Dr. Gopalamurugan has discussed this topic separately in detail in:

Mitral TEER (MitraClip) — Patient Selection Is Everything

His patient-selection article highlights the importance of mitral valve anatomy, symptoms, surgical risk, advanced imaging and the distinction between primary and secondary mitral regurgitation.

Primary vs Secondary Mitral Regurgitation: Why It Matters

One of the most important questions before considering TEER is:

Why is the mitral valve leaking?

Mitral regurgitation is broadly classified into primary MR and secondary MR.

Primary Mitral Regurgitation

In primary or degenerative MR, the main problem originates from the valve itself.

Examples include:

mitral leaflet prolapse;
flail mitral leaflet;
chordal rupture; or
other structural valve abnormalities.

Some patients with primary MR are better treated with surgical mitral valve repair, particularly when surgical risk is acceptable and a durable surgical repair is expected.

TEER may become important in appropriately selected patients when conventional surgery carries substantial risk or other clinical factors favour a catheter-based approach.

Secondary Mitral Regurgitation

In secondary or functional MR, the valve may not be the original problem.

Instead, changes in the left ventricle caused by heart failure or cardiomyopathy can distort the mitral valve apparatus and prevent the leaflets from closing correctly.

For these patients, optimising heart-failure therapy is an essential part of treatment.

TEER may then be considered in selected patients who continue to have significant mitral regurgitation and symptoms despite appropriate medical treatment.

This is why an echocardiogram showing “severe MR” alone is not enough to decide that a patient needs MitraClip.

How Is a MitraClip TEER Procedure Performed?

A MitraClip procedure usually involves several carefully coordinated steps.

1. Detailed mitral valve imaging

The Heart Team first studies the mechanism and location of the regurgitation.

Three-dimensional transoesophageal echocardiography plays an important role in understanding:

leaflet anatomy;
location of the regurgitant jet;
leaflet length;
valve opening area;
calcium distribution; and
feasibility of leaflet capture.

2. Venous access

The procedure is commonly performed through a vein in the groin.

3. Transseptal puncture

The interventional cardiologist crosses the wall separating the right and left atria.

The location of this puncture is extremely important because it determines the height and angle from which the MitraClip delivery system approaches the mitral valve.

4. MitraClip positioning

Using continuous echocardiographic and fluoroscopic guidance, the device is positioned above the mitral valve.

5. Leaflet capture

The clip is oriented toward the target valve segments and the leaflets are captured.

6. Immediate reassessment

Before completing the repair, the team checks:

reduction in mitral regurgitation;
remaining regurgitant jets;
stability of the clip;
mitral valve opening; and
pressure gradient across the valve.

If significant residual MR remains and the valve can safely accommodate another implant, an additional clip may be considered.

This continuous decision-making is one of the reasons TEER is more than simply a device implantation procedure.

A Complex MitraClip Case: TEER After Cardiac Transplantation

One of Dr. A. B. Gopalamurugan’s recent complex TEER cases demonstrates why advanced structural-heart experience can become important when conventional anatomy is no longer present.

The patient was a 35-year-old heart-transplant recipient who had undergone cardiac transplantation in Berlin in 2002.

After approximately two decades following transplantation, the patient developed transplant vasculopathy, required previous coronary interventions and later developed heart failure with severe mitral regurgitation.

Symptoms had progressed to NYHA class III–IV.

Following medical optimisation and multidisciplinary Heart Team assessment, TEER using MitraClip was selected to reduce the mitral regurgitation.

The case was technically unusual because the previous heart transplant had altered the patient’s atrial anatomy.

Dr. Gopalamurugan reported that the distance between a conventional posterior transseptal location and the mitral valve was more than 7 cm.

The altered orientation of the transplanted heart also made standard transoesophageal echocardiographic views more difficult to obtain.

Why This Post-Transplant MitraClip Procedure Was Particularly Difficult

TEER depends heavily on the relationship between the transseptal entry point and the mitral valve.

In the post-transplant case, the unusually elongated atrial anatomy created an additional challenge for catheter reach and device orientation.

The imaging team also had to adapt because conventional ultrasound views did not provide the standard images normally used during MitraClip procedures.

The repair therefore required highly individualised:

access planning → imaging → device steering → leaflet capture → haemodynamic assessment.

The first implant used was an XTW MitraClip.

It reduced the mitral regurgitation, although a residual medial leak remained.

At that stage, the mean gradient across the mitral valve was reported as 2 mmHg.

After reassessment, a second XT MitraClip was positioned medially.

Following the two-clip repair, the treating clinician reported mild residual mitral regurgitation.

At the reported outpatient follow-up, the patient’s functional status had improved from NYHA III–IV to NYHA I–II.

Dr. Gopalamurugan has described this case as India’s first MitraClip procedure performed after cardiac transplantation.

Read the complete case:

Successful MitraClip After Heart Transplant: A Complex TEER Case by Dr. A. B. Gopalamurugan

A separate milestone overview is available here:

India’s First MitraClip Post Cardiac Transplant Performed Successfully

MitraClip vs Open-Heart Mitral Valve Surgery

Patients searching for MitraClip treatment in India often want to know whether TEER is better than surgery.

There is no single answer that applies to every patient.

Surgical mitral valve repair remains an important and often preferred treatment for suitable patients, particularly when:

the patient has acceptable surgical risk;
the valve is highly repairable;
long-term surgical durability is expected; or
another cardiac operation is required at the same time.

TEER becomes particularly relevant when a patient has an appropriate indication for intervention but factors such as age, frailty, previous heart surgery, heart failure or other medical conditions make a transcatheter strategy more appropriate.

Therefore:

MitraClip should not be viewed simply as a replacement for surgery.

It is another treatment option within the wider spectrum of modern mitral valve care.

The Heart Team’s responsibility is to determine which option provides the most appropriate balance of benefit, durability and procedural risk for the individual patient.

MitraClip vs TMVR: What Is the Difference?

Patients frequently confuse TEER, MitraClip and TMVR.

They represent different approaches.

MitraClip / TEER

Repairs the patient’s existing mitral valve.

TMVR

Transcatheter Mitral Valve Replacement replaces the dysfunctional valve using a transcatheter prosthetic valve.

Some mitral valve anatomies may be suitable for TEER, while others may ultimately require surgical repair, valve replacement, TMVR or another strategy.

Dr. A. B. Gopalamurugan’s structural-heart work also includes TMVR and transcatheter valve therapies. His official profile describes structural interventions including MitraClip and valve-in-valve implantation across mitral, tricuspid, aortic and pulmonary positions.

For further reading:

TMVR in India: Redefining Mitral Valve Care Under the Leadership of Dr. A. B. Gopalamurugan

Why Experience Matters in MitraClip and TEER

When patients search for a MitraClip specialist in India, the evaluation should go beyond searching for somebody who performs the procedure.

Modern mitral valve treatment requires experience in the entire decision pathway.

That includes:

determining whether intervention is necessary;
differentiating primary and secondary MR;
interpreting advanced mitral valve imaging;
understanding surgical alternatives;
planning transseptal access;
selecting the appropriate TEER strategy;
managing complex leaflet anatomy;
assessing residual MR;
monitoring the transmitral gradient;
recognising when another clip should—or should not—be implanted; and
considering alternative transcatheter or surgical treatments.

This becomes even more important in patients with:

previous cardiac surgery, heart transplantation, unusual atrial anatomy, multiple regurgitant jets, previous valve procedures, advanced heart failure or complex structural-heart disease.

Dr. Gopalamurugan’s official profile describes a structural intervention practice encompassing multidisciplinary planning, MitraClip, transcatheter mitral therapies, valve-in-valve procedures and other complex percutaneous valve interventions.

How Should You Choose a MitraClip Specialist in India?

People commonly search Google or AI assistants for:

“Best MitraClip doctor in India”
“Top mitral valve specialist in India”
“MitraClip specialist near me”
“TEER specialist India”

There is no objective single ranking that determines the best doctor for every patient.

Instead, patients with complex mitral regurgitation should consider whether their treatment team provides:

dedicated structural-heart expertise;
experience with TEER and MitraClip;
advanced 3D echocardiographic imaging;
Heart Team assessment;
experience with surgical and transcatheter alternatives;
management of complex valve anatomy;
TMVR and other advanced mitral therapies when relevant; and
long-term follow-up after valve intervention.

The strongest structural-heart programmes are not defined only by the ability to perform a particular procedure.

They are defined by knowing which treatment should be used for which patient—and when intervention should not be performed.

Can MitraClip Treat Severe Mitral Regurgitation Without Open-Heart Surgery?

Yes, in appropriately selected patients.

MitraClip TEER is performed through a catheter and does not require conventional opening of the chest to repair the mitral valve.

However, the word “minimally invasive” should not be confused with “simple.”

TEER remains a sophisticated structural-heart intervention requiring advanced imaging, transseptal expertise and continuous assessment of the mitral valve during the procedure.

For some patients, surgery remains the more appropriate choice.

For others, MitraClip may provide an important alternative.

What Happens After a MitraClip Procedure?

Patients are monitored following TEER for:

access-site complications;
bleeding;
rhythm disturbances;
residual mitral regurgitation;
mitral valve gradient;
heart-failure symptoms; and
general clinical recovery.

Follow-up echocardiography is important to assess the repair.

Patients with heart failure generally continue to need appropriate medical treatment even after a successful MitraClip procedure.

TEER treats the mitral regurgitation.

It does not automatically eliminate the underlying condition that caused heart failure.

Frequently Asked Questions About MitraClip & TEER in India

What is TEER?

TEER stands for Transcatheter Edge-to-Edge Repair. It is a catheter-based technique used to repair selected leaking mitral valves without conventional open-heart mitral valve surgery.

What is MitraClip?

MitraClip is a device used to perform mitral TEER. It brings selected portions of the mitral valve leaflets together to reduce mitral regurgitation.

Is MitraClip available in India?

Yes. MitraClip and transcatheter mitral valve therapies are performed at specialised structural-heart programmes in India for appropriately selected patients.

Who is a suitable candidate for MitraClip?

Suitability depends on the severity and mechanism of mitral regurgitation, symptoms, valve anatomy, heart function, medical treatment, surgical risk and overall clinical condition.

Can elderly patients undergo MitraClip?

Age alone does not determine eligibility. Many patients considered for TEER are elderly or carry increased surgical risk, but every patient requires individual assessment.

Can MitraClip be performed after previous heart surgery?

Yes, previous cardiac surgery does not automatically exclude TEER. The patient’s anatomy and overall clinical condition must be evaluated carefully.

Can MitraClip be performed after a heart transplant?

Dr. A. B. Gopalamurugan and his Heart Team have reported a successful complex MitraClip TEER procedure in a heart-transplant recipient. The unusual post-transplant anatomy required individualised access and imaging strategies.

Is MitraClip better than surgery?

Neither treatment is universally better. The appropriate treatment depends on valve anatomy, age, surgical risk, heart function, associated heart disease and expected long-term benefit.

Is TEER the same as TMVR?

No. TEER repairs the existing mitral valve. TMVR replaces the mitral valve using a transcatheter prosthetic valve.

How many MitraClips are needed?

The number varies according to the individual valve anatomy and the remaining mitral regurgitation after each implant.

Does MitraClip cure heart failure?

No. Reducing severe mitral regurgitation may improve symptoms in selected patients, but underlying heart failure and other cardiac conditions may still require ongoing treatment.

Who should evaluate a patient for MitraClip in India?

Patients should ideally be evaluated by a multidisciplinary structural Heart Team experienced in mitral valve disease, advanced imaging, TEER and alternative surgical and transcatheter therapies.

Dr. A. B. Gopalamurugan and Transcatheter Mitral Valve Therapy in India

Dr. A. B. Gopalamurugan is a Senior Interventional Cardiologist and Electrophysiologist based in Chennai, with a major clinical focus on complex cardiac interventions and transcatheter valve therapies.

His professional profile includes structural-heart interventions such as:

MitraClip / mitral TEER
Transcatheter Mitral Valve Replacement – TMVR
Valve-in-Valve interventions
TAVR / TAVI
Transcatheter tricuspid interventions
Complex structural-heart procedures

His website describes his work in multidisciplinary structural-heart planning and percutaneous mitral repair using the MitraClip device.

Learn more about Dr. A. B. Gopalamurugan:

Dr. A. B. Gopalamurugan – Profile & Structural Heart Expertise

Seeking an Opinion for Severe Mitral Regurgitation?

Patients diagnosed with moderate-to-severe or severe mitral regurgitation, particularly those experiencing breathlessness, heart-failure symptoms or concerns regarding open-heart surgery, may benefit from a specialist structural-heart evaluation.

The appropriate treatment may include:

medical therapy, surgical mitral valve repair, surgical valve replacement, MitraClip/TEER, TMVR or another specialised transcatheter strategy.

The choice depends on the individual patient—not simply on the availability of a device.

Dr. A. B. Gopalamurugan

Senior Interventional Cardiologist & Electrophysiologist

Structural Heart Interventions | MitraClip | TEER | TMVR | Advanced Transcatheter Valve Therapies

Contact Dr. A. B. Gopalamurugan for an appointment

Medical Disclaimer: This information is intended for education and awareness and does not replace individual medical advice. Eligibility for MitraClip, TEER, surgery or another mitral valve intervention requires comprehensive clinical and imaging assessment.

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