Three‐dimensional transesophageal echocardiography‐guided transseptal puncture for percutaneous mitral valve edge‐to‐edge repair post‐percutaneous atrial septal defect closure

Figures

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  FIGURE 1. (A) Biplane view of bi‐commissure and left ventricular outflow tract showing a non‐prolapsed and non‐tethering leaflet morphology. (B) Color Doppler view showing wide regurgitant jet from central lesion.

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  FIGURE 2. (A) Multiplanar reconstruction showing the best puncture point (red arrow) within the fossa ovalis on a four‐chamber view. (B) Bicaval view showing the best puncture point (red arrow) out of the ASO device. (C) Estimated best puncture point (red dot) on 3D volume rendering view. (D) Estimated puncture point showing a 30° anterior side from the A2 and P2 closing line. (E) CT enface view showing the puncture point (red dot) correlated with TEE volume rendering view. (F) Demo device showing a nearly 30° approach angle. ASO, Amplatzer Septal Occluder; CT, computed tomography; Inf, inferior; LA, left atrium; MV, mitral valve; RA, right atrium; Sup, superior; TEE, transoesophageal echocardiography.

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  FIGURE 3. (A) Intraprocedural real‐time 3D‐TEE volume rendering view showing puncture needle (red arrow) as tenting of the septum. (B) Puncture needle (red arrow) guided by real‐time 3D‐TEE to the posterior side. (C) Fluoroscopic view showing puncture needle (red arrow) at the inferoposterior side of the device. (D) Steerable guide catheter approaching the mitral valve at nearly 30° as estimated by the pre‐procedural TEE. ASO, Amplatzer Septal Occluder; SGC, steerable guide catheter; TEE, transoesophageal echocardiography.

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  FIGURE 4. (A) 3D enface view of the mitral valve at baseline with an MVA of 4.02 cm2. (B) Mild residual regurgitant jet treated by one NT clip (white arrow). (C) Mitral valve resulting in MVA of 1.80 cm2 and TMPG of 2.7 mmHg. (D) Fluoroscopic view showing the inferoposterior relationship of the guide catheter. MVA, mitral valve area; TMPG, transmitral mean pressure gradient.