A 38 year old female with significant osetogensis imperfecta, severe scoliosis and severe myxomatous mitral valve insufficiency from bileaflet prolapse was referred for MitraClip. She had an additional history of COPD with CO2 retention and obstructive sleep apnea. She had been experiencing dyspnea, consistent with NYHA III symptoms.
An adult TEE transducer could not be advanced due to the severe scoliosis and pediatric TEE imaging was suboptimal for use in the procedure. TTE, fluoroscopy and volume ICE were used to successfully deploy a MitraClip.
"In patients with relative or absolute contraindication to TEE, the 4D Volume ICE catheter allows for alternative imaging guidance that was not previously available. Availability of this catheter allows us to help treat such patients and thereby help improve their quality of life."
Due to the patient's severe curvature of the spine, transesophageal (TEE) echocardiogram could not be performed. Instead, a pre-procedural transthoracic echocardiogram demonstrated severe mitral regurgitation.