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First In Human 4d Ice Echocardiogram Intraprocedural Use In Minimally Invasive Mitral Repair
Tommaso Hinna Danesi, Charles Nyman, Edoardo Zancanaro.
Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND: Zenker"s diverticulum is an absolute contraindication for Transoesophageal Echocardiogram (TEE). In recent years, 4D ICE (intracardiac) probe for echocardiography has been used in TEER (Transcatheter Edge to Edge) repair to optimize the window of operation. Currently, 4D ICE has not been utilized in cardiac surgery for mitral valve intervention. This is the first case to utilize 4D ICE in an endoscopic minimally invasive procedure for mitral valve repair in a patient with Zenker"s diverticulum.
METHODS: 69-year-old female affected by severe MR due to P2 prolapse and risk for SAM. An endoscopic minimally invasive approach has been performed, and two 5 mm Mini-port in the 3rd and 4th intercostal space were made for the 30-degree thoracoscope with a CO2 inflating 6 mm Trocar and the LV vent.A 4D ICE probe was inserted from the left femoral vein. Peripheral cannulation for CEC perfusion was performed on the right groin.The mitral valve was repaired with 2 GTX CV4 neochords sutures for P2 and a 32mm MEMO 4D complete semirigid ring was sized and implanted with 2-0 Ethibond sutures. The ring was tightened with the CorKnot fastener device. The ICE matched the real mitral valve morphology.
RESULTS:ICE showed no residual MR, no PISA, no LVOT obstruction, no SAM. Trace TR. Good biventricular function.The patient was extubated in the OR and discharged after 5 days. No complication to notify.
CONCLUSIONS:4D ICE is a suitable technique in case of absolute contraindication for TEE, also in case of surgical endoscopic mitral valve intervention. It represents a valid and equivalent substitute to TEE with great correspondence with real morphology. It may pose a future for TEE replacement and avoidance of common TEE complications like oesophageal rupture or tears.
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