Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography
Tóm tắt
Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation. It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has not been evaluated. In 28 high-surgical risk patients with moderate or severe mitral regurgitation (mean age 67 ± 10 years; 15 male), 2-D and RT 3-D TEE were used for the guidance of percutaneous edge-to-edge mitral valve repair using the MitraClip device. We performed a structured analysis to compare information and guidance capacity provided by RT 3-D TEE compared to 2-D TEE. RT 3-D TEE was found to provide advantages in 9 of 11 steps of the percutaneous mitral repair procedure. The advantages related to optimized definition of the transseptal puncture site, improved guidance of the clip delivery system towards the mitral valve, precise positioning of the clip delivery system simultaneously in anterior–posterior and lateral–medial direction above the mitral valve considering mitral valve scallops A2 and P2 and valvular regurgitation jet position, adjustment of the opened clip-arms perpendicular to the commissural line, visualization of the clip position relative to the valvular orifice and of the remaining regurgitant jet after clip closure from atrial as well as ventricular views providing double orifice images and thereby allowing confirmation or rejection of clip position in medial–lateral direction. RT 3-D TEE was inferior to 2-D TEE for leaflet grasping and analysis of leaflet insertion. In complex interventional edge-to-edge repair with the MitraClip device requiring optimal spatial information RT 3-D TEE allows improved guidance of the procedure. RT 3-D TEE guidance compared with 2-D TEE guidance alone resulted in greater operator confidence to adequately perform the procedure.
Tài liệu tham khảo
Feldman T, Wasserman HS, Hermann HC et al (2005) Percutaneous mitral valve repair using the edge-to-edge technique. J Am Coll Cardiol 46:2134–2140
Feldman T. Everest II Study. The ACC.10/i2 Summit, Atlanta, GA, March 2010
Sugeng L, Sherman SK, Salgo IS et al (2008) Live 3-dimensional transesophageal echocardiography: initial experience using the fully sampled matrix array probe. J Am Coll Cardiol 52:446–449
Balzer J, Kühl H, Rassaf T, Hoffmann R, Schauerte P, Kelm M, Franke A (2008) Real-time transesophageal three-dimensional echocardiography for guidance of percutaneous cardiac interventions: first experience. Clin Res Cardiol 97:565–574
Dodos F, Hoppe UC (2009) Percutaneous closure of complex atrial septum defect guided by real-time 3D transesophageal echocardiography. Clin Res Cardiol 98:455–456
Lang RM, Mor-Avi V, Dent JM, Kramer CM (2009) Three-dimensional echocardiography: is it ready for everyday clinical use? JACC Cardiovasc Imaging 2:114–117
Mor-Avi V, Sugeng L, Lang RM (2009) Real-time 3-dimensional echocardiography: an integral component of the routine echocardiographic examination in adult patients? Circulation 119:314–329
Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Fernandez MAG, Lang RM (2009) Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol 53:1543–1547
Taniguchi M, Akagi T, Watanabe N, Okamoto Y, Nakagawa K, Kijima Y, Toh N et al (2009) Application of real-time three-dimensional transesophageal echocardiography using a matrix array probe for transcatheter closure of atrial septal defect. J Am Soc Echocardiogr 22:1114–1120
Scohy TV, Ten Cate FJ, Lecomte PV, McGhie J, de Jong PL, Hofland J, Bogers AJ (2008) Usefulness of intraoperative real-time 3D transesophageal echocardiography in cardiac surgery. J Card Surg 23:784–786
Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler. J Am Soc Echocardiogr 16:777–802
Silvestry FR, Rodriguez LL, Herrmann HC et al (2007) Echocardiographic guidance and assessment of percutaneous repair for mitral regurgitation with the Evalve MitraClip: lessons learned from EVEREST I. J Am Soc Echocardiogr 20:1131–1140
Naqvi TZ (2009) Echocardiography in percutaneous valve therapy. JACC Cardiovasc Imaging 2:1226–1237
Webb JG, Harnek J, Munt BI et al (2006) Percutaneous transvenous mitral annuloplasty: initial human experience with device implantation in the coronary sinus. Circulation 113:851–855
Sack S, Kahlert P, Bilodeau L, Pierard LA, Lancellotti P, Legrand V, Bartunek J et al (2009) Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device. Circ Cardiovasc Interv 2:277–284