Transthoracic Echocardiography Guidance for MitraClip Procedure

Abstract Percutaneous edge-to-edge mitral valve repair using the MitraClip™ system (Abbott, Menlo Park, California, USA) has become increasingly popular in the treatment of patients with severe mitral regurgitation who have multiple co-morbidities and high or prohibitive open surgical risk. We present the case of an 80-year old woman with severe symptomatic functional mitral regurgitation at A2-P2, dilated cardiomyopathy, and congestive heart failure who was scheduled for a MitraClip™ procedure. Her presentation was further complicated by a newly diagnosed laryngeal mass with significant esophageal compression which precluded transesophageal echocardiography. As a result, the MitraClip™ procedure was instead guided using a combination of intracardiac echocardiography by the cardiologist, and transthoracic echocardiography by the anesthesiologist. The procedure was successful at dramatically reducing the degree of mitral regurgitation and demonstrates that transthoracic echocardiography performed by a cardiac anesthesiologist can be a viable option for MitraClip™ procedural guidance in patients with appropriate anatomy and absolute contraindications to TEE.