Adjunctive intracardiac echocardiography imaging from the left ventricle to guide percutaneous mitral valve repair with the mitraclip in patients with failed prior surgical rings

Objectives We evaluated intracardiac echocardiography (ICE) for adjunctively guiding the MitraClip procedure in patients with prior surgical rings. Background Transesophageal echocardiography (TEE) is the standard imaging modality used to guide the MitraClip procedure (Abbott Vascular, CA). However,...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2016-02, Vol.87 (2), p.E75-E82
Main Authors: Saji, Mike, Rossi, Ann M., Ailawadi, Gorav, Dent, John, Ragosta, Michael, Scott Lim, D.
Format: Article
Language:English
Subjects:
adjunctive
Aged
Aged, 80 and over
annuloplasty
Cardiac Catheterization - adverse effects
Cardiac Catheterization - instrumentation
Cardiac Catheterization - methods
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Feasibility Studies
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - instrumentation
Heart Ventricles - diagnostic imaging
Humans
ICE
Male
mitral regurgitation
Mitral Valve - diagnostic imaging
Mitral Valve - surgery
Mitral Valve Annuloplasty - instrumentation
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - surgery
Mitral Valve Insufficiency - therapy
Predictive Value of Tests
Retreatment
Retrospective Studies
shadowing
Treatment Failure
Treatment Outcome
Ultrasonography, Interventional - adverse effects
Ultrasonography, Interventional - methods
Virginia
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Summary:Objectives We evaluated intracardiac echocardiography (ICE) for adjunctively guiding the MitraClip procedure in patients with prior surgical rings. Background Transesophageal echocardiography (TEE) is the standard imaging modality used to guide the MitraClip procedure (Abbott Vascular, CA). However, in patients with post‐surgical anatomy, clear imaging of the mitral valve leaflets may be complex because of shadowing from the surgical ring. In these patients, TEE may be suboptimal for guiding the procedure, even using three‐dimensional imaging. Methods This retrospective analysis included data from 121 consecutive patients with mitral regurgitation who underwent MitraClip procedures at the University of Virginia. ICE was used adjunctively when there was difficulty with TEE, particularly for assessing the insertion of the posterior leaflet into the MitraClip's arms. The ICE catheter was introduced transarterially into the left ventricle and flexed to obtain the short‐axis view. Results Six patients had prior surgical rings, and in five, we used adjunctive ICE. The etiology of the mitral regurgitation was prolapse of the posterior leaflet in one patient and restriction of the posterior leaflet due to ischemic tethering in the remainder. All images were obtained from the left ventricle, and were adequate for assessing posterior leaflet insertion and the perpendicularity of the MitraClip arms. The procedural success rate was 80%. There was no adverse event related to the ICE procedure. Conclusions Mitral valve repair with the MitraClip system assisted by ICE is feasible in patients with prior surgical rings, achieving an excellent risk profile and satisfactory procedural success. © 2015 Wiley Periodicals, Inc.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.25981