Name the Cardiac Device • Xray of the Week
Figure 1. Name the cardiac device.
Figure 2. Plain radiograph demonstrating the MitraClip Cardiac Device (green arrows).
Figure 3. CT scan demonstrating the MitraClip Cardiac Device (green arrows).
Figure 4. Video demonstrating trans-septal placement technique for MitraClp from Abbott.
Mitral regurgitation (MR) is the most common form of severe valve disease in developed countries. Approved for use in 2013, the MitraClip system provides an alternate means for Mitral Valve (MV) repair in patients deemed too high risk for surgery. The system works by creating an edge to edge tissue bridge between the anterior and posterior leaflets of the MV via a clip inserted via catheter transeptally. Radiographically the device will be seen as 1 or 2 small metallic devices over the mitral valve area (Figs. 1-3). Preprocedural imaging is used to diagnose the extent and severity of the MR, and 3D - TEE is typically the imaging modality of choice as it allows for visualization and quantitative analysis of the complex geometry of the MV (Fig.4). Periprocedural imaging again also relies heavily on 3D – TEE as valve pathophysiology determines the ideal puncture site for access. Fluoroscopy and TEE are usually the modalities of choice for real time visualization during MitraClip placement. When 2D/3D TEE are used in conjunction there is an associated 28% reduction in procedural times. After placement of the system, postprocedural imaging should be utilized to assess for any residual MR, which has been shown to be a predictor of long term survival.
1. Weerakkody Y. Mitraclip device | Radiology Reference Article | Radiopaedia.org. Radiopaedia. https://radiopaedia.org/articles/mitraclip-device?lang=us. Accessed March 31, 2020.
2. Imaging in MV Interventions: MitraClip and Beyond... American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2018/08/06/13/25/imaging-in-mv-interventions. Accessed March 31, 2020.
3. Sherif MA, Paranskaya L, Yuecel S, et al. MitraClip step by step; how to simplify the procedure. Neth Heart J. 2017;25(2):125-130. doi:10.1007/s12471-016-0930-7
4. Tamburino C, Ussia GP, Maisano F, et al. Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting. Eur Heart J. 2010;31(11):1382-1389. doi:10.1093/eurheartj/ehq051
5. Chrissoheris MP, Halapas A, Papadopoulos K, Spargias K. Transcatheter MitraClip implantation facilitated by transthoracic echocardiography. J Echocardiogr. 2018;16(2):91-92. doi:10.1007/s12574-017-0358-0
6. Ramlawi B, Skiles J, Myers D, Ali O, Viens C. Transcatheter mitral repair: MitraClip technique. Ann Cardiothorac Surg. 2018;7(6):824-826. doi:10.21037/acs.2018.10.14
Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter Mitral Valve Replacement (TMVR)
Malposition of Right Atrial Lead of Permanent Pacemaker
Implanted Cardiac Loop Recorder
Wearable Cardiac Defibrillator
Impella Left Ventricular Assist Device
Micra Intracardiac Pacemaker
Neal Shah is a medical student at The Edward Via College of Osteopathic Medicine (VCOM)–Carolinas and intends on completing his residency within the field of radiology. Prior to medical school, he completed his undergraduate studies at the University of North Carolina at Chapel Hill where he majored in economics and chemistry. During his 4 years there he worked in UNC’s Biomedical Research Imaging Center where he helped develop formulations for iron-oxide nanoparticles used for MRI; it was here that his love for the field of radiology developed. He eventually wishes to also pursue his MBA and hopes to use it to help advance the field of medicine in terms of medical innovation.
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Kevin M. Rice, MD is the president of Global Radiology CME
Dr. Rice is a radiologist with Renaissance Imaging Medical Associates. and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.
Follow Dr. Rice on Twitter @KevinRiceMD
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