Excerpt

A perfect alignment of the echocardiography probe with the steerable guide catheter (SGC) might be ideal during a MitraClip procedure. However, this alignment generates an echo-shadow hampering a good view of the mitral valve increasing the chances of MitraClip misplacement (Fig. 1a). To avoid this issue, we proposed two possible solutions. The first solution involves the echocardiographist. In case the alignment is as pictured in Fig. 1a, a retroflexion of the echocardiography probe while leaving the SGC at a right angle should be performed (Fig. 1b). This simple maneuver should move the shadow away from the center giving a more obtuse view of the valve and the MitraClip without reposition of the SGC. The second possible solution, involves the interventionist. In this method, the interventionist will need to pull back the SGC and move it more lateral. By doing this maneuver, a straight view of the mitral valve will be obtained with the echocardiography probe, while the MitraClip will enter the valve in a slight obtuse angle (Fig. 1c). This position is slightly of center and the interventionist might have to compensate this misalignment by slightly repositioning the SGC.

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