Ο ΡΟΛΟΣ ΤΗΣ ΥΠΕΡΗΧΟΚΑΡΔΙΟΓΡΑΦΙΑΣ ΣΤΟ … · real-time 3-dimensional...

Ο ΡΟΛΟΣ ΤΗΣ ΥΠΕΡΗΧΟΚΑΡΔΙΟΓΡΑΦΙΑΣ ΣΤΟ ΑΙΜΟΔΥΝΑΜΙΚΟ ΕΡΓΑΣΤΗΡΙΟ

Κ. Αγγελη

Αναπλ. Καθηγητρια Καρδιολογιας

Α Πανεπ. Καρδιολογικη Κλινικη

Ιπποκρατειο Νοσοκομειο Αθηνας

• …..INTERVENTIONAL TEE IS USED TO GUIDE AND ASSESS THE PROGRESS

AND OUTCOME OF INTERVENTIONS IN A REAL-TIME, CONTINUOUS, AND

STEPWISE FASHION.

• IN THIS CONTEXT THE INTERVENTIONAL ECHOCARDIOGRAPHER BECOMES A

CO-PROCEDURALIST, PROVIDING CLEAR, TIME-EFFICIENT, STEP-BY-STEP

GUIDANCE FOR INTERVENTIONAL CARDIOLOGISTS NAVIGATING THE

COMPLEXITIES OF CARDIAC ANATOMY WITH CATHETERS, BALLOONS, AND

DEVICES. IT IS CRITICAL THAT DURING INTRA-PROCEDURAL IMAGING, THE

INTERVENTIONALIST AND ECHOCARDIOGRAPHER MAINTAIN CONSTANT

COMMUNICATION REGARDING ANATOMIC STRUCTURE AND FUNCTION AS

WELL AS THE ACTUAL PROGRESS OF THE PROCEDURE. …..

3D ECHO: A NEW DIMENSION TO ASSESS THE HEART

High spatial and temporal resolution—

which allows unique details views of

cardiac structures.

This additional information helps guide

interventional procedures leading

to safer and shorter procedures with higher

technical success,

decreased radiation exposure, and

improved patient outcomes

TRANSCATHETER INTERVENTIONS

TRANSTHORACIC OR TRANSESOPHAGEAL ECHO

• PERICARDIOPARACEDESIS (UNDER TTE GUIDANCE)

UNDER TEE GUIDANCE

• MITRAL VALVULOPLASTY IN VALVE STENOSIS

• ASD OR PATENT FORAMEN OVALE

• VSD

• AORTIC VALVE IMPLANTATION

• MITRAL CLIP IMPLANTATION IN VALVE REGURGITATION

• LEFT ATRIAL APPENDAGE CLOSURE FOR ATRIAL FIBRILLATION

• PARAVALVULAR LEAK

• PDA/ANEURYSM

• TRICUSPID – PULMONIC VALVE IMPLANTATION

• MITRAL VALVE IMPLANTATION

MITRAL STENOSIS-BALLOON VALVULOPLASTY

TRANSEPTAL PUNCTURE

MITRAL VALVE BALLOON VALVULOPLASTY

PERICARDIAL TAMPONADE

HEMODYNAMIC IMPROVEMENT

3D VARIOUS TYPES OF ASD

PRE DISK IMPLANTATION

AMPLATZER SYSTEM IMPLANTATION

ATRIAL SEPTAL DEFECT (S) CLOSURE

EDWARDS SAPIENS MEDRONIC COREVALVE

RIGHT ANNULAR-OSTIAL DISTANCE EDWARDS-SAPIENS

THREE-DIMENSIONAL 3D DATASETS CAN BE USED TO IMAGE THE AORTIC VALVE IN THE CORONAL PLANE AND MEASURE THE LEFT

ANNULAR-OSTIUM DISTANCE

MITRAL VALVE‘’CENTER OF THE VASCULAR

NETWORK’’

MITRAL VALVE‘’CENTER OF THE VASCULAR

NETWORK’’

REAL-TIME 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN MITRAL VALVE CLIPPING

MITRAL VALVE EVALUATION-2D/3D TEE

2D TEE DURING THE PROCEDURE

3D TEE DURING THE PROCEDURE

AFTER MITRAL CLIP DEPLOYMENT

SUCCESSFUL MITRAL CLIP DEPLOYMENT

PARAVALVULAR LEAK-3D DURING THE PROCEDURE

LEFT ATRIAL DEVICE APPENDAGE

• …IS A PROCEDURE RECOMMENDED TO REDUCE THE RISK OF EMBOLI

IN PATIENTS WHO ARE UNABLE TO RECEIVE ANTICOAGULANT

TREATMENT FOR ATRIAL FIBRILLATION.

• THE WATCHMAN LEFT ATRIAL APPENDAGE SYSTEM

• THE AMPLATZER CARDIAC PLUG III

THE WATCHMAN LEFT ATRIAL APPENDAGE SYSTEM

LEFT ATRIAL DEVICE APPENDAGE - AMPLATZER DEVICE

AORTIC ANEURYSM

BEFORE PLUG IMPLANTATION

AFTER IMPLANTATION

PDA

PRE DEVICE IMPLANTATION

AFTER DEVICE IMPLANTATION

TIARA VALVE TENDYNE VALVE

MEDRONIC MV

THE CAVOTRICUSPID ISTHMUS = A MUSCULAR REGION OF RA

NEW DEVICES NEW VALVES

REAL-TIME 3-DIMENSIONAL TRANSOESOPHAGEAL ECHOCARDIOGRAPHY; AN INDISPENSIBLE RESIDENT IN THE CATHETER LABORATORY

CONSTANTINA AGGELI, MICHAEL BELLAMY, NILESH SUTARIA, CHRISTODOULOSSTEFANADIS* AND PETROS NIHOYANNOPOULOS

EDITORIAL HELL J CARDIOL: JAN 2012

• RT 3D TOE IS A NOW A REGULAR RESIDENT AT THE CATHETER LABORATORY AS IT IS USED FOR

ALL SORTS OF INTERVENTIONS. THE INTERVENTIONAL ECHOCARDIOGRAPHER MUST BE AWARE

OF THE DIFFERENT IMPLANTATION PROCEDURES BEFORE ATTEMPTING TO GUIDE A PROCEDURE

AND BE APPROPRIATELY TRAINED IN A HIGH OUTPUT DEPARTMENT.

• RT 3D TOE HAS BEEN SHOWN TO PROVIDE ADDITIONAL INSIGHT IN THE ANATOMICAL,

MORPHOLOGICAL AND HAEMODYNAMIC STATEMENT. IT HAS BECOME THE IMAGING

MODALITY OF CHOICE BY MANY INTERVENTIONALISTS, AND IN MANY CASES IT SERVES AS

‘THE OPERATOR’S EYES’ TO EVALUATE, GUIDE, AND ASSESS THE RESULTS OF THE PROCEDURES

IN THE CATH LAB.

• THE UNIQUE STRUCTURAL INFO OBTAINED BY RT3D TOE OFFER SHORTER AND SAFER

INTERVENTIONAL PROCEDURES, WITH HIGHER TECHNICAL SUCCESS, THUS IMPROVING PATIENT

OUTCOMES.

INTERVENTIONAL CARDIOLOGY PROCEDURES FOR STRUCTURAL HEART

DISEASE….