心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件

1、Cardiac Ultrasound Technology and Mitral ValvuloplastyHE Yihua, LI ZhianBeijing Anahen Hospital, Capital Medical University Cardiac Ultrasound Technology Mitral apparatus：annulus、leaflets、chordae tendineae、papillary muscleSaddle shape of annulus，the highest point in the antero-posterior，the lowest p

2、oint in the medial-lateralCarpentier anatomic descriptionThree orders of chodae tendineaeAnatomy of MV Mitral apparatus：annulus、leaflEcho features of RMSMost common in the adult （99%） Thickened leaflets; adhesion of commissure; contraction of chordae tendineae Secondary calcification（most in the edg

3、e）Multiple leaflets involvedEcho features of RMSMost commo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正常Mitral valve thickening、calcEcho diagnostic k

4、ey points of balloon mitral valvuloplastySeverity 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 60mmHgEcho diagnostic

5、key points of Echo evaluation for MR Echo evaluation for MR EtiolotySeverity Location Secondary changes LV function Echo key point for therapeutic determinationEtiolotyEcho key point for theEtiology vs. therapeutic planningRheumatic Ischemic Mitral prolapseChordal ruptureMyxomatous degenerationValve

6、 replacement Excision of PMLChordal replacementArtificial chordaeEdge to edge repairLV reconstructionAnnuloplastyEtiology vs. therapeutic plannEcho diagnosis for etiology of mitral diseasesEcho diagnosis for etiology ofClassification and EtiologyNormal LeafletMotionRestricted Leaflet Motion Excess L

7、eaflet Motion Classification and EtiologyNor心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件TYPENormal Leaflet MotionNormal valvular motionLeaflet perforation or Cleft valveTYPETYPE Excess Leaflet Motion Myxomatous degeneration Lack of fibrous framework Chordal ruptureTYPEChordal ruptureChordal ruptrueFlail motionEccentric r

8、egurgitationChordal ruptureChordal ruptrueMitral prolapseMVP : Eccentric regurgitationMitral prolapseMVP : EccentriValve degenerationValve degenerationCVMDPCVMDFiber loss of elastic tissue diseaseCalcificationSCVMDValve degenerationValve degenePHVMD definition： Descripted firstly by Rippe et al in 1

9、980 Pathologies MD in the fibrous layer Dissolve Rupture Mucopolysaccharide Protein accumulation No calcification No severe fibrosis Predominantly involved mitra valvePHVMD definition：Echo findings Valve Thickness Redundancy Floppy Billowing or ballooning Prolapse Secondary changes： Regurgitation, c

10、hordal ruptureMyxomatous degenerationEcho findingsMyxomatous degeneCombined valvular involvementCombined valvular involvementThickening, floppy, redundancy of mitral valveThickening, floppy, redundancy心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件Evalve MitraClipDeployPosition and GraspEvalve MitraClipDeployPositionTYPE Re

11、stricted Leaflet Motion(RLM)RLMRHDPapilary muscle displacementValvular disease per seSymmetric DCMDissymetric IMRTYPE Restricted Leaflet Moti心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件CoronarySinusReshapingCoronary Sinus Annuloplasty-Edwards Monarch-Cardiac DimensionsCarillon-Viacor PTMA*Direct Ann

12、ulus Plication-Mitralign-Guided Delivery SystemsPosteriorAnnularReshapingCoronary Sinus- Atrial ReshapingLeft Ventricular Shape Change-Myocor (Surgical/Perc)Trans-Atrial Shape Change -Ample PS3 SystemDeviceSchematicMechanismLV Antero-Posterior ReshapingCurrent Percutaneous Technology for Functional

13、MRCoronaryCoronary Sinus AnnuloImplants consist of two epicardial pads connected by a flexible sub-valvular chordSurgical device=Intrapericardial deviceMitral valveRight VentricleAnterior PadSub-valvular chordLeft VentriclePosterior PadCoapsys ImplantiCoapsys ImplantMyocor Transpericardial Mitral Re

14、pairImplants consist of two epicarMyocor Transpericardial Mitral RepairCourtesy of Wes Pederson, Abbott, Minneapolis, Minnesota.Myocor Transpericardial MitrEcho diagnosis for location of mitral diseasesEcho diagnosis for location ofEcho diagnosis for location of mitral diseasesTEEEcho diagnosis for

15、location ofTEEEcho diagnosis for location of mitral diseasesTEEEcho diagnosis for locationTEEEcho diagnosis for location of mitral diseasesTEEEcho diagnosis for location心臟超聲波診斷技術(shù)及二尖瓣成形術(shù)(英文)課件3-Dimensional echo and intraoperative findings Echo diagnosis for location of mitral diseases3-Dimensional ec

16、ho and intraopEcho quantification for severity of mitral diseaseEcho quantification for severiQuantification of MRQuantification of MRJet length: 、Quantification of MRJet length: 、QuantificatPISA methodERO = (2r2 x VPISA) / MR-VmaxvRV = ERO X MRTVIQuantification of MRPISA methodERO = (2r2 x VPISADev

17、elopment of 3D EchoIntraoperative locationStudy of annular functionStudy of ERODevelopment of 3D EchoIntraopeSignification of studying annular morphologyFunctional MROrganic MRChanges of annular morphology and functionOptimal surgical procedure Signification of studying annuCurrent status of mitral

18、annular studyRadioactive material labeledAnimal experiment Invasive studyCurrent status of mitral annulMeasurement variables Height Projection areaM-A Antero-posterior diameterLongitudinal Displacement and velocity of annulusMeasurement variables Height PIMR MVPAnnulus flattened、increased Antero-pos

19、terior diameter穹隆體積增加No obvious change of annular shapeIMR MVPAnnulusDynamic change of 3D-MVA During a cardiac cycle0.000.180.360.720.90Dynamic change of 3D-MVA0.0003D analysis of mitral valveCoaptation area and indexCoaptation index=Surface area in early diastole Surface area in late systoleSurface area in early diastoleCoaptation area3D analysis of mitral valveCoaCoaptation area and indexCoaptation area and indexCoaptation area and indexCoaptation area and indexQuantification of tenting volumeQuantification of ten