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Advanced imaging methods to improve transseptal puncture during percutaneous mitral valve repair

Wolsink, I. (2020) Advanced imaging methods to improve transseptal puncture during percutaneous mitral valve repair.

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Abstract:Mitral regurgitation (MR) is the second most common heart valve disorder, affecting more than 10% of the population 75 years or older. Percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular) has gained popularity to treat mitral regurgitation (MR) in patients deemed high risk for surgery. Accurate transseptal puncture (TSP) is a crucial step to achieve a good guiding catheter position during the procedure. Therefore it is expected that a better TSP site improves the MitraClip procedure. The aim of this study was to determine whether the planned TSP site, using a novel computed tomography (CT) scan and echo image fusion methodology, corresponded with the actual TSP site, and if this was related to procedure time and outcome. The mitral annulus and inter atrial septum were segmented in 26 patients (mean age 75 years, 50% female) undergoing PMVR. The optimal TSP site was based on (1) perpendicular distance of 35 – 45mm to the mitral annulus, and (2) posterior position relative to the aorta. Optimal TSP site was planned using a cardiac CT scan and dedicated software. The CT scan was exported to an ultrasound system. After alignment with the three-dimensional trans oesophageal echo (TEE) image, the coordinates of the actual TSP site were determined. The distance between the optimal and actual TSP site was measured in three ways: (1) difference in height above the mitral annulus, (2) absolute distance to the actual TSP site, and (3) the angle between the anterior peak of the mitral annulus and the TSP site. Comparisons were made on procedure time. The distance between the optimal and actual TSP site showed to be more than 5mm in 85% of the cases. The mean difference in height above the mitral annulus was 6.9mm. The device time, defined as the time from TSP to clip release, showed to be 32% longer in cases with an absolute distance between the optimal and actual TSP site larger then 11mm. However, this did not reach statistical significance (p=0.2), likely due to small sample size. CT-echo image fusion is an applicable method to plan TSP. Preoperative planning can be implemented in the clinical workflow by using fusion of the CT scan and the TEE images during the procedure. This study suggests that image fusion based guiding may improve TSP site, reduce PMVR procedure time and potentially lead to more effective reduction of MR. Guidance of MitraClip procedure using live CT and TEE fusion imaging has to be applied more often in order get more experience and to show advantages.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/81058
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