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Transesophageal echocardiography mitraclip

Yuji Itabashi, Hiroto Utsunomiya, Shunsuke Kubo, Yukiko Mizutani, Hirotsugu Mihara, Mitsushige Murata, Robert J Siegel, Saibal Kar, Keiichi Fukuda, Takahiro Shiota
BACKGROUND: Postprocedural mitral stenosis (MS) is a main limitation for MitraClip™ (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip™ implantation, which indicated postprocedural mitral stenosis (MS). METHODS: We studied 79 patients who were implanted with MitraClip™ in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior-posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set...
December 2, 2017: Journal of Cardiology
Adam A Dalia, Michael Essandoh
The MitraClip is a percutaneously implanted device approved for the treatment of symptomatic organic mitral regurgitation in poor surgical candidates. Despite its proven efficacy and safety for mitral regurgitation treatment, the MitraClip may unmask the true afterload of the left ventricle by removing the low-pressure left atrial system and may cause acute left ventricular systolic failure (afterload mismatch). Rapid diagnosis and treatment of afterload mismatch is crucial to ensure optimal patient outcomes...
October 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
Theresa Herbrand, Silke Eschenhagen, Tobias Zeus, Eva Kehmeier, Katharina Hellhammer, Verena Veulemans, Malte Kelm, Jan Balzer
BACKGROUND: Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip(®) therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients. METHODS: TMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip(®) implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software...
September 20, 2017: European Journal of Medical Research
Hiroto Utsunomiya, Yuji Itabashi, Sayuki Kobayashi, Florian Rader, Asma Hussaini, Moody Makar, Alfredo Trento, Robert J Siegel, Saibal Kar, Takahiro Shiota
Percutaneous edge-to-edge repair using the MitraClip system causes reduction in mitral valve area (MVA). However, its clinical impact is not fully elucidated. This study assessed the impact of postprocedural MVA reduction on pulmonary hypertension and outcomes. A total of 92 patients with grades 3 to 4 + mitral regurgitation (MR) who underwent MitraClip therapy were retrospectively reviewed. Using intraprocedural, 3-dimensional transesophageal echocardiography, postprocedural MVA was obtained by 2 optimized planes through the medial and lateral orifices of the repaired valve...
August 15, 2017: American Journal of Cardiology
Michael Huntgeburth, Robert Schier, Roman Pfister, Henrik Ten Freyhaus, Kristina Dahlem, Kai Friedrichs, Stephan Baldus, Volker Rudolph
OBJECTIVES: We evaluated end-tidal CO2 (etCO2), which has been proposed to assess acute hemodynamic changes, to guide percutaneous edge-to-edge mitral valve repair (PMVR) with the MitraClip system. METHODS: Thirty-nine patients (aged 78 ± 14 years) undergoing PMVR for moderate-to-severe mitral regurgitation (MR) of primary and secondary etiology were included. General anesthesia was maintained with sevoflurane and constant ventilation parameters to ensure stable etCO2 tension...
2017: Cardiology
Johannes Patzelt, Yingying Zhang, Harry Magunia, Rezo Jorbenadze, Michal Droppa, Miriam Ulrich, Shanglang Cai, Henning Lausberg, Tobias Walker, Tobias Wengenmayer, Peter Rosenberger, Juergen Schreieck, Peter Seizer, Meinrad Gawaz, Harald F Langer
BACKGROUND: Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS: 101 patients with severe MR not eligible for conventional surgery underwent PMVR...
January 26, 2017: International Journal of Cardiology
Mehmet Cilingiroglu, Konstantinos Marmagkiolis
Transesophageal echocardiography (TEE) assessment after MitraClip implantation is limited by unequal orifices and jets, eccentric regurgitation, and the acute change of the annulus geometry. Periprocedural real-time invasive hemodynamic assessment of the mitral valve function requires experience in hemodynamic monitoring interpretation. However, it provides excellent accuracy as it does not take into account the changes of the mitral apparatus geometry and jet direction after MitraClip placement. While we seek to expand indications of Mitraclip to other patient subgroups, we should consider routine ancillary invasive hemodynamic assessment, in order to optimize our understanding, procedural results...
December 2016: Catheterization and Cardiovascular Interventions
Ezgi Erkılıç, Elvin Kesimci, Cihan Döğer, Tülin Gümüş, Süleyman Ellik, Orhan Kanbak
OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68...
August 2016: Turkish Journal of Anaesthesiology and Reanimation
Jeffrey M Paulsen, Thomas W Smith
Echocardiography continues to be the most effective imaging tool for the diagnosis and follow-up of mitral valve disease. This review addresses the use of transthoracic echocardiography and transesophageal echocardiography in the planning and guidance of transcatheter mitral valve therapies. Many of the echo-imaging guidance techniques are applicable to transcatheter intervention as a whole. However, given that the MitraClip is the only device approved for mitral regurgitation at present, specific attention is paid to this procedure, with additional focus on the guidance of noncentral repair...
January 2016: Interventional Cardiology Clinics
Azeem Latib, Antonio Mangieri, Eustachio Agricola, Paolo Denti, Damiano Regazzoli, Francesco Giannini, Marco B Ancona, Fabrizio Monaco, Ottavio Alfieri, Antonio Colombo
An 84-year-old man with cardial senile amyloidosis and severe tricuspid regurgitation was referred for right sided heart failure symptoms. The patient was scheduled for a percutaneous treatment due to the prohibitive risk of surgery. Two MitraClips were implanted using a transjugular approach with successful echocardiographic and clinical results. This case shows the rational of the procedural with a bicuspidalization of the valve demonstrated at the three dimensional transesophageal echocardiography.
February 2017: International Journal of Cardiovascular Imaging
Azad Mashari, Ziyad Knio, Jelliffe Jeganathan, Mario Montealegre-Gallegos, Lu Yeh, Yannis Amador, Robina Matyal, Rabya Saraf, Kamal Khabbaz, Feroze Mahmood
OBJECTIVE: To evaluate the feasibility of obtaining hemodynamic metrics of echocardiographically derived 3-dimensional printed mitral valve models deployed in a pulse-duplicator chamber. DESIGN: Exploratory study. SETTING: Tertiary-care university hospital. PARTICIPANTS: Percutaneous MitraClip procedure patient. INTERVENTIONS: Three-dimensional R-wave gated, full-volume transesophageal echocardiography images were obtained after deployment of the MitraClip device...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Jan Horstkotte, C Kloeser, H Beucher, E Schwarzlaender, R S von Bardeleben, P Boekstegers
INTRODUCTION: Intraprocedural assessment of mitral regurgitation (MR) is a challenging issue during the MitraClip procedure, which might influence not only the position but also the number of MitraClips implanted. Though transesophageal echocardiography (TEE) is the predominant tool used during the MitraClip procedure, MR assessment might be facilitated by a multimodality approach including continuous and simultaneous determination of left atrial and left ventricular (LV) pressure. METHODS: 86 consecutive patients (76...
December 2016: Catheterization and Cardiovascular Interventions
Romina Murzilli, Giovanni Pedrazzini, Elena Pasotti, Tiziano Moccetti, Francesco Fulvio Faletra, Laura Anna Leo
Percutaneous edge-to-edge mitral valve repair with the MitraClip device has been shown to be a safe and effective procedure in selected patients with moderate-to-severe mitral regurgitation. Two-dimensional transesophageal echocardiography (2D TEE) is the primary imaging modality for guidance of the procedure. Real-time three-dimensional (3D) TEE has recently been used as additional imaging modality during the MitraClip procedure. In comparison with 2D TEE, 3D TEE provides additional information in several steps of the procedure, including precise positioning of the clip delivery system into the left atrium, correct alignment of the clip arms perpendicular to the coaptation line and confirmation of the correct grasping location...
October 2015: Giornale Italiano di Cardiologia
Jan Balzer, Tobias Zeus, Katharina Hellhammer, Verena Veulemans, Silke Eschenhagen, Eva Kehmeier, Christian Meyer, Tienush Rassaf, Malte Kelm
AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions. METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and MitraClip(®) procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the EchoNavigator(®)-system...
September 26, 2015: World Journal of Cardiology
Mike Saji, Ann M Rossi, Gorav Ailawadi, John Dent, Michael Ragosta, D Scott Lim
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...
February 1, 2016: Catheterization and Cardiovascular Interventions
Lei Yu, Zhaoxia Pu, Xianbao Liu, Xiaofeng Bao, Pintong Huang, Wei He, Yan Feng, Jianjing Lin, Xiangdong You, Jian'an Wang
OBJECTIVE: To investigate the value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation. METHODS: From October 2013 to June 2014, 6 transcatheter mitral valve repair operations were performed in our hospital for symptomatic patients with severe functional mitral regurgitation (MR), transesophageal echocardiography was applied to guide the implantation of 2 pieces of MitraClip. Clinical data are retrospectively analyzed to evaluate implantation timing and approach of the 2nd piece of MitraClip, as well as the immediate effect of the interventional therapy...
April 2015: Zhonghua Xin Xue Guan Bing za Zhi
Robert Schueler, Can Öztürk, Jan Arne Wedekind, Nikos Werner, Florian Stöckigt, Fritz Mellert, Georg Nickenig, Christoph Hammerstingl
OBJECTIVES: The purpose of this study was to investigate the persistence rates of iatrogenic atrial septal defect (iASD) after interventional edge-to-edge repair with serial transesophageal echocardiography examinations and close clinical follow-up (FU). BACKGROUND: Transcatheter mitral valve repair (TMVR) with the MitraClip system (Abbott Vascular, Abbott Park, Illinois) is a therapeutic alternative to surgery in selected high-risk patients. Clip placement requires interatrial transseptal puncture and meticulous manipulation of the steerable sheath...
March 2015: JACC. Cardiovascular Interventions
Philippe Debonnaire, Victoria Delgado, Jeroen J Bax, Nina Ajmone Marsan
No abstract text is available yet for this article.
November 2014: EuroIntervention
Christiane Gruner, Bernhard Herzog, Dominique Bettex, Christian Felix, Saurabh Datta, Matthias Greutmann, Oliver Gaemperli, Simon A Müggler, Felix C Tanner, Juerg Gruenenfelder, Roberto Corti, Patric Biaggi
BACKGROUND: Echocardiographic quantification of mitral regurgitation (MR) can be challenging if the valve geometry is significantly altered. Our aim was to compare the quantification of MR by the recently developed real time three-dimensional (3D) volume color flow Doppler (RT-VCFD) method to the conventional two-dimensional (2D) echocardiographic methods during the MitraClip procedure. METHODS: Twenty-seven patients (mean age 76 ± 8 years, 56% male) were prospectively enrolled and severity of MR was assessed before and after the MitraClip procedure in the operating room by 3 different methods: (1) by integrative visual approach by transesophageal echocardiography, (2) by transthoracic 2D pulsed-wave Doppler-based calculation of aortic stroke volumes (SV) and mitral inflow allowing calculation of regurgitant volume, and (3) by transthoracic 3D RT-VCFD-based calculation of regurgitant volume...
July 2015: Echocardiography
Talea Remy, Stefan C Bertog, Nina Wunderlich, Laura Vaskelyte, Ilona Hofmann, Sameer Gafoor, Horst Sievert
BACKGROUND: MitraClip® therapy is an alternative to conventional surgery. The aim was to characterize the mitral annular geometry pre- and postrepair with the MitraClip® taking into account the regurgitation mechanism. METHODS: We retrospectively collected pre- and postprocedural transesophageal echocardiography data in 46 patients. Patients were categorized as having isolated degenerative (DMR, n = 18), isolated functional (FMR, n = 9) or a combination of both functional and degenerative mitral regurgitation (MMR, n = 19)...
October 2014: Journal of Interventional Cardiology
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