Percutaneous Edge to Edge Mitral Valve Repair by MitraClip скачать в хорошем качестве

Percutaneous Edge to Edge Mitral Valve Repair by MitraClip

This a Case of Percutaneous Edge to Edge Mitral Valve Repair - MitraClip. The Clinical History is 82 Year Old Male. Severe MR with FLAIL PML (Prosterior Mitral Leaflet) Post Holter shown Recurrent NSVT. Patient had CAD. Patent Stent in LAD with mild ISR. Plan is Mitral Valve repair with MitraClip. Patient was brought to Cathlab in fasting with surgical backup team. Patient was intubated in the Cathlab. Right Femoral vein was punctured under Ultrasound guidance. Femoral Vein was secured with Perclose - Proglide suture. This 2D TEE showing the Four Chamber View with colour showing Mitral Regurgitation and Severity and Jet Origin.. Bicaval View to Confirm Transseptal site and to assess inter-arterial septum. Bicommisural View to assess leaflet anatomy, Coaptation line and clip positioning feasibility. This is the 3D LA En Face View for precise MitraClip Navigation, Grasping Strategy, Leaflet and Commissure Orientation before Clip Deployment. 2D TEE Septal Puncture SA View showing Septal Puncture was done Mid- posterior using SL1, 8F Sheath with RBK – 171 cm Needle under TEE and Fluoroscopy. TEE showing MitraClip Crossing and Clip Orientation. Sheath Crossed through inter-atrial septum. Sheath placed in LT Atrium. MitraClip entering into the LV through mitral valve (Bi Plane Commisural View). 3D LA View for Clip Orientation. Preloaded MitraClip was passed into the LA. Under TEE and Fluro, MitraClip was crossed across Leaflets. MitraClip was deployed to hold A2 P2 leaflets after the confirmation of MitraClip position by TEE and Fluoroscopy. TEE showing Clip Deployment and Grasping of Leaflets. Device across Mitral Valve, and Clip arms are Opened. Grasping the Leaflets. 3D image confirming Grasping the Leaflets. Post Clip Mitral Gradient and Post Clip MR Check. Post Grasping Mitral Gradient was 3mmHg Post Clip MR Check. Pulmonary Vein Flow was checked. Post Deployment 3D imaging showing Owl eyes. Post Procedural Minimal Pericardial Effusion was seen. Post Procedure ICCU Course & Complication Management. Post Procedure Patient was extubated and shifted to ICU. In view of abnormal breathing, 2D echo was done and shown Pericardial Effusion. Emergency Pericardiocentesis was done at bedside. During procedure patient developed respiratory distress, worsening GCS and unstable hemodynamics (BP-40mm per mercury). Patient was immediately intubated. Pericardiocentesis was done. Around 800ml drained. 2 units of PRBC were infused periprocedure. 2D echo revealed severe LV dysfunction. Patient progressed to Cardiogenic shock. IABP was inserted. After electrolyte correction, IV albumin, and 3 CRRT sessions, urine output improved. Pericardial pigtail and IABP were removed; patient extubated to BiPAP. At discharge, 2D Echo showed minimal PE with improving LV function. On follow up, no Pericardial Effusion with fair LV function."