Utilization of two- and three-dimensional transesophageal
echocardiography in successfully guiding transcatheter mitral valve in
bioprosthetic mitral valve/mitral ring implantation without
complications in patients with thrombus in left atrium/left atrial
appendage.
Abstract
Background. The presence of thrombus in the left atrial
appendage (LAA) and/or LA body has so far been considered a
contraindication to the transcatheter mitral valve (MV) in bioprosthetic
MV/ MV annuloplasty ring implantation. Objective. The aim of
this study is to describe, for the first time to our knowledge, the
utilization of both two-dimensional (2D) and three-dimensional (3D)
transesophageal echocardiography (TEE) in successfully performing
without any embolic or other complications transcatheter MV in
bioprosthetic MV/ mitral ring implantation using the apical approach in
a group of 12 patients (pts) with co-existing LAA and/or LA body
thrombus. Patients, Methods and Results. All pts were severely
symptomatic with severe bioprosthetic MV stenosis in 9, severe native MV
stenosis with a previous surgically inserted MV annuloplasty ring in 1
and severe MV regurgitation secondary to bioprosthetic cusp rupture in 2
pts. Thrombus in the LAA and/ or LA body was noted in all pts by 2D and
3DTEE. All pts were at high or prohibitive risk for surgery and all
refused surgery. Utilizing both 2D and 3DTEE, especially 3DTEE, the
guidewires and the prosthesis deployment system could be manipulated
under direct vision through the MV bioprosthesis into the LA and left
superior pulmonary vein bypassing and avoiding any contact with the
thrombus. The transcatheter procedure was successfully accomplished in
all patients with relief of stenosis/ regurgitation and amelioration of
symptoms with no embolic or other complications during the procedure and
over a mean follow-up period of 21 months. Conclusion. Our
small study demonstrates the feasibility of successfully performing
transcatheter MV in bioprosthetic MV/ MV annuloplasty ring procedure in
pts with thrombus in LAA and/or LA body without any embolic or other
complications.