Continuous Left Atrial Pressure Monitoring During MitraClip

Abstract

a b s t r a c tThe ability of microbes to accelerate chloramine decay to the same degree as under severe nitrification, but without the signs of severe nitrification is reported. Traditionally, only nitrification is believed to microbiologically challenge the stability of chloramine. Chloraminated water containing high amount of natural organic matter (10e12 mg L À1 of dissolved organic carbon (DOC)) was fed to four lab scale reactors connected in series. Each reactor had one day retention time with a total of four days in total. The decay coefficient was observed to be a maximum of 0.06 h À1 without substantial changes in ammonia, nitrite or nitrate levels. Despite very low chloramine residuals, nitrite only increased to less than 0.012 mg-N L À1 , indicating a mildly nitrifying condition. Previously reported decay coefficient (0.001e0.006 h À1 ) for the condition was an order less. Changing of the feed to a new water from the same source, but with a low DOC (of 4 mg L À1 ) led to the onset of nitrification complying biostability. The maximum observed chloramine decay coefficient with severe nitrification was 0.085 h À1 . Therefore, microbes present under mildly nitrifying condition can be as destructive as that in severely nitrifying condition. For better control of chloramine, attention on microbes present under mild nitrification is needed.

Left atrial hemodynamics and left ventricular remodeling –predictors of outcomes after Transcatheter mitral valve repair with the MitraClip device

“…It is also known that intra‐procedural and inhospital outcomes are better in patients in whom continuous left atrial pressure monitoring is performed when compared to those in whom it is not . Acute changes in mean left atrial pressure are associated with improvement in the 6‐min walk test . There is a gap in the current knowledge base about the relationship if any between 90‐days outcomes (mortality and rehospitalizations) and continuous hemodynamic monitoring during the MitraClip procedure.…”

Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair

“…All patients underwent continuous left atrial pressure (LAP) monitoring during TMVR. Briefly, a 4F fluid‐filled multipurpose catheter was inserted into the left atrium alongside the MitraClip steerable guide using previously described methods 11. This allowed for continuous LAP recording throughout the procedure.…”

Comparison of left atrial pressure monitoring with dedicated catheter versus steerable guiding catheter during transcatheter mitral valve repair

“…Our technique for continuous LAP monitoring has previously been described . Briefly, after transseptal access has been obtained, two stiff J‐tip wires (one 0.032 Amplatz extra‐stiff and one 0.035 Ampltaz super‐stiff) are advanced into the left superior pulmonary vein through an 8F Mullens sheath.…”

“…Assessment of acute intraprocedural results is primarily guided by transesophageal echocardiography (TEE), however quantification of MR after a clip is implanted can be challenging due to distortion of mitral valve anatomy and acoustic shadowing by the MitraClip device and delivery catheter . Continuous left atrial pressure (LAP) monitoring has recently emerged as a complementary tool to TEE which can provide real time assessment of the changes in left atrial v wave and mean pressure during the MitraClip procedure, potentially improving procedural results . Changes in left atrial v wave pressure during MitraClip have also been shown to predict clinical improvement in 6 min walk distance at 30 day follow‐up after the procedure .…”