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1、Cardiac Ultrasound Technology and Mitral Valvuloplasty,HE Yihua, LI Zhian Beijing Anahen Hospital, Capital Medical University,Mitral apparatus：annulus、leaflets、chordae tendineae、papillary muscle Saddle shape of annulus，the highest point in the antero-posterior，the lowest point in the medial-lateral
2、Carpentier anatomic description Three 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 thicken
3、ing、calcification、restricted motion PML and AML: equidirectional motion; city wall changes Decreased EF-slope （non-specific finding） M-mode “A” peak wave disappeared Doming sign,Echo diagnostic key points of balloon mitral valvuloplasty,Severity of MS MVA5mmHg Severity of MR Combined valve disease o
4、r anomaly Mitral valve conditions Degree of mobility and calcification No commissure calcification No subvalvular chordal shortening At rest: SPAP50mmHg At stress: PGmean 15mmHg SPAP 60mmHg,Echo evaluation for MR,Etioloty Severity Location Secondary changes LV function,Echo key point for therapeutic
5、 determination,Etiology vs. therapeutic planning,Rheumatic,Ischemic,Mitral prolapse,Chordal rupture,Myxomatous degeneration,Valve replacement Excision of PML Chordal replacement Artificial chordae Edge to edge repair LV reconstruction Annuloplasty,Echo diagnosis for etiology of mitral diseases,Class
6、ification and Etiology,Normal Leaflet Motion,Restricted Leaflet Motion,Excess Leaflet Motion,TYPE Normal Leaflet Motion Normal valvular motion Leaflet perforation or Cleft valve,TYPE Excess Leaflet Motion Myxomatous degeneration Lack of fibrous framework Chordal rupture,Chordal rupture,Chordal ruptr
7、ue Flail motion Eccentric 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 Predom
8、inantly 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 Gr
9、asp,TYPE Restricted Leaflet Motion(RLM),Coronary Sinus Reshaping,Coronary Sinus Annuloplasty,-Edwards Monarch -Cardiac DimensionsCarillon -Viacor PTMA*,Direct Annulus Plication,-Mitralign -Guided Delivery Systems,Posterior Annular Reshaping,Coronary Sinus- Atrial Reshaping,Left Ventricular Shape Cha
10、nge,-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 chord Surgical device=Intrapericardial devi
11、ce,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
12、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 VPIS
13、A) / MR-Vmaxv,RV = ERO X MRTVI,Quantification of MR,Development of 3D Echo,Intraoperative location Study of annular function Study of ERO,Signification of studying annular morphology,Functional MR,Organic MR,Changes of annular morphology and function,Optimal surgical procedure,Current status of mitr
14、al 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 an
15、alysis 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
16、of annuloplasty,Residual MR Residual or new MS SAM or prosthetic strut protrusion with LVOT obstruction Left or right ventricular dysfunction Coronary occlusion from annuloplasty or valve ring suture Pseudoaneurysm formation at site of debridement of mitral annular calcification Shunts related endocarditis AR secondary to suture placement or annular distortion Embolism events,3D TEE Pre-Procedure,After anesthesia,Before anesthesia,Evaluation for MR at different status,