Thread by @adnanalkhouli

🧵Step-by-Step ICE-guided MitraClip

1/8 Transseptal puncture

📌3D ICE allows biplane imaging - ⬆️ TSP precision

📌ICE>TEE in presence of septal occluders (visualize infer-pos FO)

📌 Measuring TSP-MV height is feasible w a modest learning curve

#CardioTwitter #MedEd

2/8 Baseline Assessment of MR

📌 After dilating the septum, cross with ICE to LAA —> insert the CDS

📌 Biplane imaging here displays two views identical to the LVOT/commissural views on TEE

3/8 Quality of Grasping⛔️

This👇is NOT a good grasp - see posterior leaflet curling. Don’t take it! high risk of SLDA

4/8 Quality of Grasping ✅

This👇is better. You can see adequate grasping of both leaflets

5/8 Checking Leaflet Insertion

Good insertion & immobilization of the leaflets

6/8 Clip Release

7/8 Glass View post-TEER 😎

🙏 Dr.Sinak (not on Twitter) for his assistance in this case and others

8/8 Final 💭

💢Is ICE ready to routinely guide MV TEER? No, but may be adequate in selected cases (simple anatomy, no TEE option)

💢Can I do w ICE in RA? No, LA ICE is still needed at present

💢IC & INTV echo partnership is 🔑 to advance ICE 4 SHD INTV

💢The future is bright!