Intracardiac Echocardiography-Guided Percutaneous Mitral Balloon Commissurotomy: Technique and Early Experience.

Background

Percutaneous mitral balloon commissurotomy (PMBC) is the gold standard for the treatment of patients with symptomatic rheumatic mitral valve (MV) stenosis and favorable valve morphology. Intracardiac ultrasound (ICE)-guided PMBC is an attractive alternative to standard transesophageal echocardiography guidance for simplification of procedure and avoiding general anesthesia.

Methods

We conducted a retrospective analysis of all ICE-guided PMBC cases at our institution between July 2020 and November 2023. Procedural success was defined as post-PMBC MV area ≥1.5 cm

Results

We identified 11 subjects for whom ICE-guided PMBC was attempted. The mean age of the subjects was 61.7 (±12.1) years. All, but one, were females. Out of the 11 subjects, 2 did not undergo PMBC; one had baseline severe MV regurgitation identified on ICE, and the other developed a pericardial effusion following transeptal puncture that needed an urgent pericardial window. The protocol-defined procedural success was achieved in all nine patients who underwent PMBC. Post-PMBC mean MV gradient was 4.4 (±2.0) as compared to 11.1 (±2.9) mmHg at baseline. At 6-month follow-up, 8 of the 9 patients had ≤New York Heart Association class II symptoms.

Conclusions

ICE-guided PMBC appears to be feasible and safe. ICE-guided PMBC offers several advantages over transesophageal echocardiography guidance including improving patient comfort and eliminating the need for patient intubation and general anesthesia.

Informations de copyright

© 2024 Published by Elsevier Inc. on behalf of Cardiovascular Research Foundation.

Déclaration de conflit d'intérêts

K. Al-Azizi reports a relationship with Edwards Lifesciences Corporation, Shockwave Medical Inc, Medtronic, and Abbott that includes consulting or advisory services. Karim Al-Azizi reports a relationship with Philips North America LLC that includes board membership and consulting or advisory services. S. Potluri reports a relationship with Boston Scientific Corp, Medtronic, Abbott, Terumo Medical Corp, and Shockwave Medical Inc that includes board membership and consulting or advisory services. The other authors had no conflicts to declare.