ABSTRACT
Patients who present with both severe mitral and tricuspid regurgitation who are symptomatic despite optimal medical therapy and at prohibitive risk for surgery pose a significant therapeutic challenge. The MitraClip device (Abbott Vascular) is approved for percutaneous mitral valve repair in high-risk and non-operative patients, and has also been used for tricuspid valve repair. Imaging support for percutaneous edge-to-edge tricuspid valve repair has not been reported and is a vital part of the procedure. Here, we present a periprocedural imaging strategy for percutaneous tricuspid valve repair with the MitraClip device using a bicuspidization technique.
Subject(s)
Heart Valve Prosthesis , Mitral Valve Insufficiency , Mitral Valve/diagnostic imaging , Tricuspid Valve Insufficiency , Tricuspid Valve/diagnostic imaging , Aged , Cardiac Imaging Techniques , Equipment Design , Female , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Humans , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Perioperative Care/methods , Risk Adjustment/methods , Severity of Illness Index , Treatment Outcome , Tricuspid Valve/surgery , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/physiopathology , Tricuspid Valve Insufficiency/surgeryABSTRACT
Left ventricular assist devices (LVADs) have been used to treat advanced heart failure refractory to medical management, as bridge therapy to myocardial recovery, as bridge therapy to cardiac transplantation, or as destination therapy for patients with unfavorable transplant candidacy. Neurologic complications are some of the most common and devastating complications in these patients. Preoperative carotid ultrasound is, therefore, a standard evaluation in patients at risk for cerebrovascular disease. Postoperative carotid artery Doppler sonography is performed in those patients with neurologic symptoms. It is likely, therefore, that sonographers, radiologists, and other physicians working in a center where LVADs are implanted will likely encounter a carotid artery Doppler study in this patient group. To our knowledge, the carotid Doppler findings in these patients have never been published. We review the Doppler ultrasound findings in 6 patients after LVAD insertion.
