Author + information
- Received January 29, 2015
- Accepted February 12, 2015
- Published online June 1, 2015.
- Mackram F. Eleid, MD,
- Saurabh Sanon, MD,
- Guy S. Reeder, MD,
- Rakesh M. Suri, MD, DPhil and
- Charanjit S. Rihal, MD, MBA∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Charanjit S. Rihal, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota 55905.
We describe the novel use of continuous left atrial pressure (LAP) monitoring to guide the MitraClip (Abbott Vascular, Santa Clara, California) procedure. In addition to transesophageal echocardiography, we have found that direct measurement of LAP is also a useful tool to determine the hemodynamic efficacy of mitral regurgitation reduction with MitraClip. The currently available MitraClip steerable sheath system does not allow for measurement of LAP while the clip delivery system is in use, thereby limiting LAP measurements to only before or after the clip delivery system is used and the clip has already been released. We describe a simple technique for measuring LAP continuously, without the need for an additional transseptal puncture (Figure 1). Continuous LAP can be a highly useful decision aid, not only to determine a hemodynamic endpoint, but also to determine the relative efficacy of a specific MitraClip grasping location (e.g., 2 different grasping locations may similarly reduce the color Doppler jet, but 1 produces a greater reduction in LAP) (Figures 2 and 3⇓⇓).
Dr. Suri has been a consultant for Sorin and Abbott; has received research grants from Sorin, St. Jude Medical, Abbott, Edwards Lifesciences; and has patent applications with Sorin. Dr. Rihal has received research grants from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 2 authors contributed equally to this work.
- Received January 29, 2015.
- Accepted February 12, 2015.
- American College of Cardiology Foundation