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IMAGES IN INTERVENTION

Continuous Left Atrial PressureMonitoring During MitraClipAssessing the Immediate Hemodynamic Response

Mackram F. Eleid, MD, Saurabh Sanon, MD, Guy S. Reeder, MD, Rakesh M. Suri, MD, DPHIL,Charanjit S. Rihal, MD, MBA

W e describe the novel use of continuousleft atrial pressure (LAP) monitoring toguide the MitraClip (Abbott Vascular,

Santa Clara, California) procedure. In addition totransesophageal echocardiography, we have foundthat direct measurement of LAP is also a usefultool to determine the hemodynamic efficacy ofmitral regurgitation reduction with MitraClip. Thecurrently available MitraClip steerable sheath systemdoes not allow for measurement of LAP while theclip delivery system is in use, thereby limitingLAP measurements to only before or after the clipdelivery system is used and the clip has alreadybeen released. We describe a simple technique formeasuring LAP continuously, without the need for

From the Division of Cardiovascular Diseases, Mayo Clinic College of Me

consultant for Sorin and Abbott; has received research grants from Sorin, St.

patent applications with Sorin. Dr. Rihal has received research grants from A

they have no relationships relevant to the contents of this paper to disclose.

Manuscript received January 29, 2015; accepted February 12, 2015.

an additional transseptal puncture (Figure 1). Contin-uous LAP can be a highly useful decision aid, notonly to determine a hemodynamic endpoint, butalso to determine the relative efficacy of a specificMitraClip grasping location (e.g., 2 different graspinglocations may similarly reduce the color Dopplerjet, but 1 produces a greater reduction in LAP)(Figures 2 and 3).

REPRINT REQUESTS AND CORRESPONDENCE: Dr.Charanjit S. Rihal, Mayo Clinic College of Medicine,200 First Street S.W., Rochester, Minnesota 55905.E-mail: rihal@mayo.edu.

KEY WORDS left atrial pressure, MitraClip, monitoring

dicine, Rochester, Minnesota. Dr. Suri has been a

Jude Medical, Abbott, Edwards Lifesciences; and has

bbott Vascular. All other authors have reported that

The first 2 authors contributed equally to this work.

FIGURE 1 Left Atrial Pressure Monitoring Method

(A) After transseptal access in an appropriate location, we advance 2 guidewires into the left superior pulmonary vein (yellow arrow). (B)

Following dilation of the atrial septum, we advance a 4-F multipurpose catheter into the left superior pulmonary vein (yellow arrow). (C and D)

After the MitraClip steerable sheath is advanced into the left atrium (LA) alongside the 4-F multipurpose catheter, the catheter is pulled back

into the LA for continuous pressure monitoring throughout the procedure (yellow arrow).

Eleid et al. J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 8 , N O . 7 , 2 0 1 5

Phantom Vessel in a Case of AMI J U N E 2 0 1 5 : e 1 1 7 – 9

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FIGURE 2 Left Atrial Pressure Changes During MitraClip Procedure

Left atrial pressure (LAP) in a patient with severe mitral regurgitation that is due to flail P2 scallop who had a reduction in LA v-wave from

50 mm Hg to 35 mm Hg after the first clip deployment. On the right, continuous LAP during closing of the second clip arms shows dramatic

reduction of LA v-wave to 18 mm Hg, confirming hemodynamically effective mitral regurgitation reduction. ART ¼ radial artery pressure.

FIGURE 3 Color Doppler Assessment of Mitral Regurgitation

Transesophageal color Doppler assessment in the same patient.

J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 8 , N O . 7 , 2 0 1 5 Eleid et al.J U N E 2 0 1 5 : e 1 1 7 – 9 Phantom Vessel in a Case of AMI

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