OR13-7
Intracardiac Echocardiography Guided Percutaneous Mitral Balloon Commissurotomy Case Series: A New Approach to an old Procedure
Presenter
Ahmed Hassanin, MD, MPH, Baylor Scott & White The Heart Hospital - Plano, Plano, TX
Ahmed Hassanin, MD, MPH1, Modar Alom, MD1, Youssef Yaacoub, MD2, Srini Potluri, M.D., FSCAI3 and Karim Al-Azizi, M.D., FSCAI4, (1)Baylor Scott & White The Heart Hospital - Plano, Plano, TX, (2)Baylor Scott and White Heart Hospital Plano, Frisco, TX, (3)Baylor Scott & White The Heart Hospital - Plano, Frisco, TX, (4)Baylor Scott & White Health, Frisco, TX
Keywords: Structural Heart Disease (SHD) and TEER/TMVR/Mitral Valve
Background:
Percutaneous mitral balloon commissurotomy (PMBC) is recommended for the treatment of symptomatic rheumatic mitral valve stenosis (RMS) in patients with suitable mitral valve anatomy. Intracardiac ultrasound (ICE) guided PMBC is an attractive alternative to standard transesophageal echocardiography (TEE) guidance.
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 mitral valve area ≤1.5 cm 2 ; or an increase of ≥0.5 cm 2 in mitral valve area associated with echocardiographic mitral regurgitation (MR) that is ≤ moderate post-PMBC. Six-month follow up data were collected.
Results
We identified 11 subjects in 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 MR 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 9 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 ≤ NYHA class II symptoms.
Conclusions:
ICE guided PMBC appears to be feasible and safe. ICE guided PMBC offers several advantages over TEE guidance including improving patient comfort and eliminating the need for patient intubation and general anesthesia.