Clinical Case
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."

Dr. Gagan SIngh
Associate Clinical Professor
UC Davis Health
Sacramento
California
Pre-Procedure
02Transseptal Puncture
01Circle Tool
01Fluoroscopic Image
01Procedural Imaging
02Post-Deployment Imaging
03- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
4D volume ICE Imaging with and without color Doppler

Pre-Procedural Imaging
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.

Pre-Procedural Imaging
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.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Transseptal Puncture
The ACUSON AcuNav Volume ICE catheter was then positioned in the mid-right atrium in the "Home View." The catheter was rotated clockwise to approximately the 4 o'clock position to obtain the atrial septal view.
The goal was to visualize the fossa ovalis (thin portion) which is the optimal puncture site for transseptal access.
Depending on patient anatomy, a slight posterior tilt may be required to better visualize a greater portion of the septum.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Circle Tool
Typically, the goal is to cross the septum superiorly and posteriorly at a distance of 4.5cm from the mitral annular plane.
As demonstrated in this image, the circle tool was used to identify the distance between the mitral leaflets and the mitral annulus.
Adequate transseptal position ensures the MitraClip deployment system has room for a straight downward trajectory to the apex of the ventricle with minimal manipulations.

Fluoroscopic Image
A fluoroscopic image is used to identify the position of the ACUSON AcuNav Volume ICE catheter and the TEE transducer.
The patient's severe scoliosis was also observed under fluoroscopy.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Procedural Imaging
Use of Bi-plane imaging with and without color Doppler was useful in guiding the device to the best position and documenting the decreased mitral regurgitation.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Procedural Imaging
Use of Bi-plane imaging with and without color Doppler was useful in guiding the device to the best position and documenting the decreased mitral regurgitation.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
After deploying the MitraClip, 2D and color flow Doppler revealed two small residual mitral regurgitation jets.
The ACUSON AcuNav Volume ICE catheter provided the ability to see the heart in real-time and visualize the regurgitation before, during and after the MitraClip was deployed.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
4D volume ICE Imaging with and without color Doppler
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
4D volume ICE Imaging with and without color Doppler

Pre-Procedural Imaging
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.

Pre-Procedural Imaging
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.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Transseptal Puncture
The ACUSON AcuNav Volume ICE catheter was then positioned in the mid-right atrium in the "Home View." The catheter was rotated clockwise to approximately the 4 o'clock position to obtain the atrial septal view.
The goal was to visualize the fossa ovalis (thin portion) which is the optimal puncture site for transseptal access.
Depending on patient anatomy, a slight posterior tilt may be required to better visualize a greater portion of the septum.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Circle Tool
Typically, the goal is to cross the septum superiorly and posteriorly at a distance of 4.5cm from the mitral annular plane.
As demonstrated in this image, the circle tool was used to identify the distance between the mitral leaflets and the mitral annulus.
Adequate transseptal position ensures the MitraClip deployment system has room for a straight downward trajectory to the apex of the ventricle with minimal manipulations.

Fluoroscopic Image
A fluoroscopic image is used to identify the position of the ACUSON AcuNav Volume ICE catheter and the TEE transducer.
The patient's severe scoliosis was also observed under fluoroscopy.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Procedural Imaging
Use of Bi-plane imaging with and without color Doppler was useful in guiding the device to the best position and documenting the decreased mitral regurgitation.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Procedural Imaging
Use of Bi-plane imaging with and without color Doppler was useful in guiding the device to the best position and documenting the decreased mitral regurgitation.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
After deploying the MitraClip, 2D and color flow Doppler revealed two small residual mitral regurgitation jets.
The ACUSON AcuNav Volume ICE catheter provided the ability to see the heart in real-time and visualize the regurgitation before, during and after the MitraClip was deployed.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
4D volume ICE Imaging with and without color Doppler
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
Post-Deployment Imaging
4D volume ICE Imaging with and without color Doppler


- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.
- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.

- Chapters
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- captions off, selected
This is a modal window.
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End of dialog window.
- Chapters
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- captions off, selected
This is a modal window.
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- Chapters
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- captions off, selected
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- Chapters
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This is a modal window.
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- Chapters
- descriptions off, selected
- captions settings, opens captions settings dialog
- captions off, selected
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
End of dialog window.