eae teaching course - clinical applications of...
TRANSCRIPT
![Page 1: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/1.jpg)
European Society of Cardiology copyright -All right reserved
MITRAL REGURGITATION
Prof. Patrizio LANCELLOTTI, MD, PhD
CHU Sart Tilman, Heart Valve Disease Clinic,
University of Liège, Belgium
![Page 2: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/2.jpg)
European Society of Cardiology copyright -All right reserved
ANATOMY FUNCTION
LEFT ATRIUM
ANNULUS ANNULUS
LEAFLETS LEAFLETS
CHORDAE CHORDAE
PAPILLLARY PAPILLARY
MUSCLES MUSCLES
LEFT VENTRICLE
MITRAL VALVE
![Page 3: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/3.jpg)
European Society of Cardiology copyright -All right reserved
VALVE ANALYSIS
Etiology The Cause of
Valve Disease
LesionsThe Result of the
Disease Process
DysfunctionThe Result of
the Lesions
![Page 4: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/4.jpg)
European Society of Cardiology copyright -All right reserved
Quality of tissue (Pliability of leaflet)
Quantity of tissue
Calcifications (Leaflet, LV wall)
LESIONS
![Page 5: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/5.jpg)
European Society of Cardiology copyright -All right reserved
TYPE I : NORMAL LEAFLET MOTION
- ANNULAR DILATION
- LEAFLET PERFORATION
TYPE II : EXCESSIVE LEAFLET MOBILITY
- PROLAPSE
- FLAIL
TYPE III : REDUCED LEAFLET MOBILITY OR MOTION
- CHORDAE SHORTENING, LEAFLET THICKENING
- INCOMPLETE COAPTATION
DYSFUNCTION: CARPENTIER’S
CLASSIFICATION
![Page 6: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/6.jpg)
European Society of Cardiology copyright -All right reserved
CAUSES
ETIOLOGY
MECHANISM NON-ISCHEMIC ISCHEMIC
ORGANIC Rheumatic, prolapse,flail Ruptured PM
leaflet, endocarditis, etc
FUNCTIONAL Cardiomyopathy Post-MI
![Page 7: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/7.jpg)
European Society of Cardiology copyright -All right reserved
DEGENERATIVE (Barlow, FED, Marfan)
ballooning, prolapse, flail
Mitral annulus is saddle shaped
Parasternal Long Axis View
![Page 8: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/8.jpg)
European Society of Cardiology copyright -All right reserved Thickened (> 5mm), Redundant tissue
Barlow disease Fibroelastic Deficiency
P2 Prolapse
![Page 9: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/9.jpg)
European Society of Cardiology copyright -All right reserved
FUNCTIONAL MR
Normal leaflets, Annular dilation, LV dilation + spherical +
Altered geometry + PMs displacement + WM abnormalities
![Page 10: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/10.jpg)
European Society of Cardiology copyright -All right reserved
SR
IL
![Page 11: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/11.jpg)
European Society of Cardiology copyright -All right reserved
![Page 12: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/12.jpg)
European Society of Cardiology copyright -All right reserved
![Page 13: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/13.jpg)
European Society of Cardiology copyright -All right reserved
A B
C D
![Page 14: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/14.jpg)
European Society of Cardiology copyright -All right reserved
A2
P2
A1
P1
A3
P3
A B C
![Page 15: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/15.jpg)
European Society of Cardiology copyright -All right reserved
TTE TEE
TEETTE
A B
CD
![Page 16: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/16.jpg)
European Society of Cardiology copyright -All right reserved
![Page 17: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/17.jpg)
European Society of Cardiology copyright -All right reserved
Post Commissure – P3
Type II P3
![Page 18: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/18.jpg)
European Society of Cardiology copyright -All right reserved
Anterior commissure – P1
![Page 19: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/19.jpg)
European Society of Cardiology copyright -All right reserved
![Page 20: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/20.jpg)
European Society of Cardiology copyright -All right reserved
Limitations
• Technical factors (Gain settings, PRF), Direction of the jet (Coanda effect)
• Loading conditions, Left atrial size
• Aliasing velocity of 50-60 cm/s
• Optimize color gain setting
• Need blood pressure evaluation
• Value ??? (separate mild to severe)
Color flow mapping
![Page 21: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/21.jpg)
European Society of Cardiology copyright -All right reserved
VENA CONTRACTA WIDTHThe narrowest portion of the MR jet downstream from the orifice
• 2 orthogonal planes, Color sector as narrow as possible
• Zoom to optimize visualization
• Maximal lateral and temporal resolution
• Mild MR < 0.3 cm, Severe MR 0.7 cm
Limitations
• Lateral resolution
• Phasic changes
• Multiple jets
• Non-circular orifice
![Page 22: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/22.jpg)
European Society of Cardiology copyright -All right reserved
VENA CONTRACTA WIDTH
![Page 23: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/23.jpg)
European Society of Cardiology copyright -All right reserved
PISA METHOD
1. Optimize 2-D color
2. Zoom or RES
3. Shift the color scale
4. Measure the PISA
5. MR CW Doppler
6. Calculate mitral ERO/RV
1. Less affected by hemodynamic factors
2. Etiology of MR or Other valve disease
do not affect ERO calculation
3. Can be used with eccentric jets
BENEFITS
![Page 24: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/24.jpg)
European Society of Cardiology copyright -All right reserved
Parameters
Mild Moderate Severe
Qualitative
Mitral valve morphology
Colour flow MR jet
Flow convergence zone
CW signal of MR jet
Semi-quantitative
VC width (mm)
Pulmonary vein flow
Mitral inflow
TVI mit/TVI Ao
Quantitative
EROA (mm²)
R Vol (ml)
Normal/Abnormal
Small, central jets
No or small
Faint/Parabolic
< 3
Systolic dominance
A wave dominant
<1
< 20
< 30
Normal/Abnormal
Intermediate
Intermediate
Dense/Parabolic
Intermediate
Systolic blunting
Variable
Intermediate
20-29 ; 30-39!
30-44 ; 45-59!
Flail leaflet/ ruptured PMsVery large central jet or eccentric
jet adhering, swirling and
reaching the posterior LA wall
Large
Dense/Triangular
7 (>8 for biplane)
Systolic flow reversal
E wave dominant (>1.5 cm/s)
1.4
40
60
+ LV and LA sizes + sPAP
Integrating indices of MR severity
![Page 25: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/25.jpg)
European Society of Cardiology copyright -All right reserved
- LV DIMENSION AND EF
- LV SHAPE, LA SIZE
- PULMONARY PRESSURES
- < 50 mmHg at rest
- < 60 mmHg at exercise
- VENTRICULAR FUNCTION ?
- DYNAMIC COMPONENT AT EXERCISE
CONSEQUENCES
GUIDELINES REFER TO M-MODE
MEASUREMENTS
Variability in a spherical LV
![Page 26: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/26.jpg)
European Society of Cardiology copyright -All right reserved
WHAT TO FOLLOW IN AN ASYMPTOMATIC PATIENT
WITH NORMAL LV FUNCTION
Moderate MR clinical every year + echo every 2 years
Severe MR clinical every 6 months + echo every 1 year
* or if EF 60-65% (ESD 40-45 mm) echo every 6 months
- PROGRESSION OF MR : MARKED INDIVIDUAL DIFFERENCES
- PROGRESSION OF LESION :
- NEW FLAIL LEAFLET
- INCREASE OF ANNULUS SIZE
- EVOLUTION OF LV END-SYSTOLIC DIMENSION OR VOLUME- LV EJECTION FRACTION- LA SIZE AND AREA- PULMONARY SYSTOLIC PRESSURE- EXERCISE CAPACITY
- OCCURRENCE OF ATRIAL ARRHYTHMIAS
![Page 27: EAE teaching course - Clinical applications of ...assets.escardio.org/assets/presentations/other2010/eae...EAE teaching course - Clinical applications of echocardiography: old and](https://reader031.vdocument.in/reader031/viewer/2022012009/613267fcdfd10f4dd73a6dc1/html5/thumbnails/27.jpg)
European Society of Cardiology copyright -All right reserved