Role of Echocardiography in Mitral Clip (Case Selection to Insertion) Transthoracic and Transesophageal Echocardiographic Imaging for Selection of Appropriate Candidates and Intraprocedural Guidance for Percutaneous Mitral Valve Repair using MitralClip in Degenerative and Functional Mitral Regurgitation

هشتمين كنگره بين المللي قلب و عروق رضوي

6 الي 8 مرداد 1395، مشهد - ايران

Presentation Type: Speech
Abstract:

Mitral regurgitation (MR) has a high prevalence in older patient population. Common etiologies are degenerative and functional MR secondary to myocardial remodeling in ischemic and non-ischemic dilated cardiomyopathy. Percutaneous transcatheter repair of mitral valve (PMVR) using mitralClip is a new treatment option for these patients whereby a clip is placed at the edges of anterior and posterior mitral leaflets creating a double orifice mitral valve (MV). Because of the lack of direct visualization, pre- procedural transthoracic echo (TTE) imaging is crucial to select candidates with suitable MV anatomy to ensure successful PMVR. TTE provides accurate qualitative and quantitative assessment of MR severity, to determine MR etiology as degenerative, ischemic, or functional and allows assessment of other valves, cardiac function and hemodynamics as well as provides screening of mitral valve anatomy including coaptation depth and length in ischemic MR and of flail gap and flail width in degenerative MR. PMVR is best suited for MR originating from the central scallops of MV although posteriorly or anterior scallops can also be repaired. Transesophageal echo (TEE) provides definitive mitral valve anatomy and suitability for repair. Intraprocedural TEE is critical for procedural guidance from selecting the puncture site of interatrial septum to clip deployment and assessment of residual mitral regurgitation. TEE is able to determine the immediate effect of MR reduction on cardiac physiology. TEE confirms the final MR grade and size of residual atrial septal defect before the completion of the procedure. TEE allows immediate detection of procedural complications such as development of thrombus on catheters, pericardial effusion, and tangling of device with chordae. 3D TEE has significantly shortened the procedure time by providing simultaneous display of orthogonal planes as well as surgical-type enface views of MV.