Measuring Transmitral Gradient With Single Radial Access Using a Dual-Lumen Catheter

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105219

Khaldoon Rashid MD , Sheena Amin MD , Rumman Syed MD , Eric Rothstein MD

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Abstract

Objective

To measure the transmitral gradient (TMG) with a dual-lumen pigtail catheter with single radial-arterial access to obtain simultaneous left atrial (LA)/left ventricular (LV) pressures.

Key Steps

Key steps include the following: 1) with radial arterial access, use a 5-F TIG 4.0 diagnostic catheter, and advance a 0.035-inch J-wire across the aortic valve in a retrograde fashion; 2) advance catheter into LV; 3) advance floppy 0.035-inch Tru-Torque wire beyond the mitral valve into the LA and pulmonary vein; 4) advance TIG catheter over the wire into the LA; 5) exchange TIG catheter for a Langston dual-lumen catheter; 6) place distal pigtail portion into the LA and proximal pressure port in the LV, obtain concurrent LA/LV pressures, and calculate TMG and MVA with Gorlin equation.

Potential Pitfalls

In patients with atrial fibrillation, advancing the catheter across the mitral valve presents risk of dislodging a preexisting thrombus from the left atrial appendage.

Take-Home Message

This method offers a simple and efficient approach to a direct TMG assessment.

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使用双腔导管测量单径向通道的透射梯度

目的采用单根-动脉双腔细尾导管测量左心房/左心室（LV）同时压力。关键步骤关键步骤包括以下步骤：1)桡动脉通路，使用5-F TIG 4.0诊断导管，并以逆行方式将0.035英寸的j型线穿过主动脉瓣；2)将导管推进左室；3)将0.035英寸的Tru-Torque软丝穿过二尖瓣进入左室和肺静脉；4)将TIG导管穿过导线进入LA；5)将TIG导管置换为Langston双腔导管；6)将尾纤尾远端部分分别置入左室和左室近端压力口，获取左室/左室并发压力，用Gorlin方程计算TMG和MVA。潜在的缺陷在房颤患者中，将导管穿过二尖瓣有可能使左心房附件原有的血栓移位。这种方法为直接评估TMG提供了一种简单而有效的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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