心脏超声波诊断技术及二尖瓣成形术英文.ppt

Cardiac Ultrasound Technology and Mitral Valvuloplasty,HE Yihua,LI ZhianBeijing Anahen Hospital,Capital Medical University,Mitral apparatus：annulus、leaflets、chordae tendineae、papillary muscleSaddle shape of annulus，the highest point in the antero-posterior，the lowest point in the medial-lateralCarpentier anatomic descriptionThree orders of chodae tendineae,Anatomy of MV,Echo features of RMS,Most common in the adult（99%）Thickened leaflets;adhesion of commissure;contraction of chordae tendineae Secondary calcification（most in the edge）Multiple leaflets involved,正常,Mitral valve thickening、calcification、restricted motionPML and AML:equidirectional motion;city wall changesDecreased EF-slope（non-specific finding）M-mode“A”peak wave disappearedDoming sign,Echo diagnostic key points of balloon mitral valvuloplasty,Severity of MSMVA5mmHgSeverity of MRCombined valve disease or anomalyMitral valve conditionsDegree of mobility and calcificationNo commissure calcificationNo subvalvular chordal shorteningAt rest:SPAP50mmHgAt stress:PGmean 15mmHg SPAP 60mmHg,Echo evaluation for MR,EtiolotySeverity Location Secondary changes LV function,Echo key point for therapeutic determination,Etiology vs.therapeutic planning,Rheumatic,Ischemic,Mitral prolapse,Chordal rupture,Myxomatous degeneration,Valve replacement Excision of PMLChordal replacementArtificial chordaeEdge to edge repairLV reconstructionAnnuloplasty,Echo diagnosis for etiology of mitral diseases,Classification and Etiology,Normal LeafletMotion,Restricted Leaflet Motion,Excess Leaflet Motion,TYPENormal Leaflet MotionNormal valvular motionLeaflet perforation or Cleft valve,TYPE Excess Leaflet Motion Myxomatous degeneration Lack of fibrous framework Chordal rupture,Chordal rupture,Chordal ruptrueFlail motionEccentric regurgitation,Mitral prolapse,MVP:Eccentric regurgitation,Valve degeneration,PHVMD definition：Descripted firstly by Rippe et al in 1980 Pathologies MD in the fibrous layer Dissolve Rupture Mucopolysaccharide Protein accumulation No calcification No severe fibrosis Predominantly involved mitra valve,Echo findings Valve Thickness Redundancy Floppy Billowing or ballooning Prolapse Secondary changes：Regurgitation,chordal rupture,Myxomatous degeneration,Combined valvular involvement,Thickening,floppy,redundancy of mitral valve,Evalve MitraClip,Deploy,Position and Grasp,TYPE Restricted Leaflet Motion(RLM),CoronarySinusReshaping,Coronary Sinus Annuloplasty,-Edwards Monarch-Cardiac DimensionsCarillon-Viacor PTMA*,Direct Annulus Plication,-Mitralign-Guided Delivery Systems,PosteriorAnnularReshaping,Coronary Sinus-Atrial Reshaping,Left Ventricular Shape Change,-Myocor(Surgical/Perc),Trans-Atrial Shape Change,-Ample PS3 System,Device,Schematic,Mechanism,LV Antero-Posterior Reshaping,Current Percutaneous Technology for Functional MR,Implants consist of two epicardial pads connected by a flexible sub-valvular chordSurgical device=Intrapericardial device,Coapsys Implant,iCoapsys Implant,Myocor Transpericardial Mitral Repair,Myocor Transpericardial Mitral Repair,Courtesy of Wes Pederson,Abbott,Minneapolis,Minnesota.,Echo diagnosis for location of mitral diseases,Echo diagnosis for location of mitral diseases,TEE,TEE,Echo diagnosis for location of mitral diseases,TEE,Echo diagnosis for location of mitral diseases,3-Dimensional echo and intraoperative findings,Echo diagnosis for location of mitral diseases,Echo quantification for severity of mitral disease,Quantification of MR,Jet length:、,Quantification of MR,PISA method,ERO=(2r2 x VPISA)/MR-Vmaxv,RV=ERO X MRTVI,Quantification of MR,Development of 3D Echo,Intraoperative locationStudy of annular functionStudy of ERO,Signification of studying annular morphology,Functional MR,Organic MR,Changes of annular morphology and function,Optimal surgical procedure,Current status of mitral annular study,Measurement variables,Height,Projection area,M-A,Antero-posterior diameter,Longitudinal Displacement and velocity of annulus,IMR MVP,Annulus flattened、increased Antero-posterior diameter,穹隆体积增加,No obvious change of annular shape,Dynamic change of 3D-MVA During a cardiac cycle,3D analysis of mitral valve,Coaptation area and index,Coaptation index,=,Surface area in early diastole Surface area in late systole,Surface area in early diastole,Coaptation area,Coaptation area and index,Coaptation area and index,Quantification of tenting volume,Intraoperative monitoring,Complications of annuloplasty,Residual MRResidual or new MSSAM or prosthetic strut protrusion with LVOT obstructionLeft or right ventricular dysfunctionCoronary occlusion from annuloplasty or valve ring suturePseudoaneurysm formation at site of debridement of mitral annular calcificationShunts related endocarditis AR secondary to suture placement or annular distortionEmbolism events,3D TEE Pre-Procedure,After anesthesia,Before anesthesia,Evaluation for MR at different status,