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Transesophageal Echocardiography During MitraClip® Procedure

Guarracino, Fabio MD*; Baldassarri, Rubia MD*; Ferro, Baldassare MD*; Giannini, Cristina MD, PhD; Bertini, Pietro MD*; Petronio, Anna Sonia MD; Di Bello, Vitantonio MD; Landoni, Giovanni MD; Alfieri, Ottavio MD§

doi: 10.1213/ANE.0000000000000215
Cardiovascular Anesthesiology: Special Article

The percutaneous mitral valve (MV) repair procedure performed with the MitraClip® delivery system is increasingly used to treat severe mitral regurgitation in high-risk patients. The treatment involves percutaneous insertion and positioning of a clip between the MV leaflets. Transesophageal echocardiography (TEE) plays a key role in the procedure by providing information regarding clip navigation, clip alignment to the MV coaptation line, transmitral advancement of the system, leaflet grasping, confirmation of valve tissue catching, and assessment of the final result. Real-time 3-dimensional TEE has increasing value in percutaneous MV repair providing high-quality visualization of both the heart and the intravascular devices. Optimal visualization by 3-dimensional TEE is obtained through both the atrial and ventricular aspects. In contrast to MV surgery, where TEE is involved in the prebypass assessment phase and in evaluation of the final repair, TEE is mandatory to guide management during MitraClip® repair. Cardiac anesthesiologists may provide assistance to interventional cardiologists during the procedure itself in addition to their anesthetic-related tasks.

From the *Department of Cardiothoracic Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana; Cardiac Thoracic and Vascular Department, University of Pisa, Pisa; and Departments of Anesthesiology and Intensive Care, and §Cardiac Surgery, Università Vita-Salute San Raffaele, Milano, Italy.

Accepted for publication January 24, 2014.

Funding: Department of Cardiothoracic Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. No external funds.

The authors declare no conflicts of interest.

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Reprints will not be available from the authors.

Address correspondence to Fabio Guarracino, MD, Department of Cardiothoracic Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Italy, Via Paradisa 2 Cisanello -56123 Pisa. Address e-mail to fabiodoc64@hotmail.com.

© 2014 International Anesthesia Research Society