Aortic stenosis with concomitant mitral regurgitation
|
|
- Aubrey Ramsey
- 5 years ago
- Views:
Transcription
1 Challenges in the evaluation and management of aortic stenosis Aortic stenosis with concomitant mitral regurgitation S1 Philippe Unger, M.D., FESC Erasme Hospital - Université Libre de Bruxelles Brussels, Belgium S2
2 No conflict of interest
3 Case #1 72 y-o man Recent onset AF, persistent severe HF despite cardioversion Dobutamine
4 Low flow low gradient AS SVi 23 ml/m² Ao max V 309 cm/s Ao MPG 25 mm Hg AVA 0.74 cm² Severe organic MR ERO 40 mm² Reg vol 37 ml
5 MVR CE Magna 31 mm (with chordal preservation) + AVR CE Magna 25 mm preoperative postoperative
6 Case #2 80 y-o woman, severe aortic stenosis Repeated pulmonary edemas during the last 6 months LVEF 25%
7 BSA 1.7 m² BP 105/75 mm Hg Max velocity 344 cm/s Mean gradient 26 mm Hg SVI = 20 ml/m² AVA = 0.45 cm² (0.26 cm²/m²) Low flow low gradient AS
8 ERO 25 mm² Rvol 36 ml
9 Transcatheter aortic valve implantation (Edwards Sapien 23 mm; transfemoral approach) Pre Post ERO 25 mm²; Rvol 36 ml ERO 6 mm²; Rvol 10 ml
10 Case #3 78 y-o man, severe aortic stenosis, severe heart failure BSA 1.9 cm² Mean aortic PG 29 mm Hg SVI 20 ml/m² AVA 0.45 cm² Low flow low gradient AS
11 R =. ERO 17 mm² RV 26 ml
12 Transcatheter aortic valve implantation (Edwards Sapien XT 26 mm; transapical approach) Pre Post ERO 17 mm² RV 26 ml ERO 21 mm² RV 26 ml
13 AS + MR: Questions Functional significance? Prognostic value? Does AVR/TAVI affect the severity of MR? Predictors of MR down-grading after AVR/TAVI? Therapeutic strategy?
14 Prevalence of MR in patients undergoing an isolated aortic valve procedure Aortic valve replacement TAVI Tunick Am J Cardiol 1990 Adams Am J Cardiol 1990 Tassan-Mangina Clin Cardiol 2003 N = 7758 Variable inclusion /exclusion criteria Webb Circulation 2007 Tzikas Cath Cardiovasc Intv 2010 Durst J Heart Valve Diss 2011 N = 950 Organic 50-80% Moazami J Card Surg 2004 Barreiro Circulation 2005 Ruel Circulation 2006 Mainly nonquantitative MR assessement Hekimian JASE 2011 De Chiara Cath Cardiovasc Intv 2011 Samim Int J Cardiol 2011 Mainly nonquantitative MR assessement Caballero-Borrego Eur J Cardiothor Surg 2008 Toggweiler JACC 2012 Waisbren Ann Thor Surg 2008 Wan J Thorac Cardiovasc Surg 2009 Jeong Am J Cardiol 2011 mild: 30-80% moderate: ±15% mild: 70-80% moderate: 20-35% Severe 5-10%
15 LV remodelling Mitral valve deformation leaflet tethering LV pressure LV-LA pressure gradient Aortic stenosis Mitral regurgitation Functional tolerance Atrial fibrillation Diagnostic challenge Low flow low gradient aortic stenosis forward stroke volume Postop EF Unger P, Lancellotti P, et al. Heart 2010;96:9
16 Aortic stenosis and mitral regurgitation Functional significance? Prognostic value? Does AVR/TAVI affect the severity of MR? Predictors of MR down-grading after AVR/TAVI? Therapeutic strategy?
17 Operative Mortality X2 STS Database Euro Heart Survey STS database Iung B, et al. EuroHeart Survey
18 Survival Mitral valve repair with AV replacement is superior to double valve replacement 100 % P= AV replacement and MV repair Double valve replacement Repair: N=295 Replacement: N= Mean follow-up 6.9±5.9 yrs years Gillinov AM, et al. J Thorac Cardiovasc Surg 2003; 125: 1372
19 Prognostic significance of moderate versus mild MR before surgical AV replacement A meta-analysis including 17 studies and 3053 patients Nil/mild versus moderate/severe OR/HR CI P Comparative 30-Day mortality Comparative 30-Day mortality; Functional MR only year overall survival < year overall survival < year overall survival Harling L, et al. Eur J Cardiothor Surg 2011;40:1087
20 Prognostic significance of moderate versus mild MR before TAVI Higher mortality 30 days No difference after 30 days adjusted HR: 2.10 ( , p = 0.02) 92.5% 86.5% adjusted HR: 0.82 ( , p = 0.42) 83.7% 67.%9 66.2% 58.5% MR mild: n = 319 Moderate: n = 89 Severe: n = 43 Toggweiler, S. et al. J Am Coll Cardiol 2012;59:2068
21 Aortic stenosis and mitral regurgitation Functional significance Prognostic value Does AVR/TAVI affect the severity of MR? Predictors of MR down-grading after AVR/TAVI? Therapeutic strategy?
22 Impact of isolated aortic valve replacement on mitral regurgitation First author, Year Aetiology of MR Number of patients Timing of the postop echo Method of MR assessment % of patients with improvement in MR Tunick 1990 Functional + Organic N = 27 mild MR 58 days CFM 67% Adams 1990 Organic + Functional N = 46 mild MR 6 months PW mapping 27% Harris 1997 Functional N=28 mild MR 2.5 months CFM 82% Brasch 2000 Organic + Functional N = 16 moderate MR 2.2 months CFM 44% 16 studies Christenson 2000 Functional N = 58 mild MR 1 week/5 months CFM 46%/60% Tassan-Mangina 2003 Functional N = 23 mild MR 19 days CFM 61% Moazami 2004 Functional N = 80 mild MR > 60 days CFM 45% 1294 patients with MR Functional only (10) or Functional + organic (6) Mostly retrospective Mainly qualitative or ½ quantitative Barreiro 2005 Organic + Functional N = 70 moderate MR Early postoperative CFM 82% if functional 35% if organic Ruel 2006 Functional N = MR 18 months ASE recommendations 44-74% MR assessement Vanden Eynden 2007 Organic + Functional N = 80 moderate MR 1 year CFM and PW Doppler 5-10% 35% mapping, PV flow Caballero-Borrego 2008 Functional N =153 non-severe MR Before discharge CFM and PW, PV flow 72% From OR up to 18 months Waisbren 2008 Functional (No CABG) N = 167 moderate MR Intraoperative Vena contracta width 66% Wan 2009 Functional N=159 moderate MR Discharge ASE recommendations 76% Unger 2008 Organic + Functional N=52 mild MR Early postoperative Matsumura 2010 Functional N=110 moderate MR Early postoperative Improvement 55-65% (27-82%) Deterioration PISA 69% CFM 64% Joo 2011 Functional N=118 mild MR 57 months PISA 72%
23 postop reduction (%) Quantitative changes in MR after AV replacement P< vs ERO P=0.034 vs ERO ERO Reg Vol Reg jet/la area Unger, Lancellotti et al. Am J Cardiol. 2008; 102:
24 Aortic stenosis and mitral regurgitation Functional significance Prognostic value AVR/TAVI affects the severity of MR Predictors of MR down-grading after AVR/TAVI? Therapeutic strategy?
25 Predictors of MR down-grading after isolated AVR First author, Year Aetiology of MR Preoperative predictive factors of MR improvement Tunick Am J Cardiol 1990 Functional + organic MR severity Adams Am J Cardiol 1990 Functional + organic None Harris Am J Cardiol 1997 Functional Low LV fractional area, Large left atrial size Brasch Am J Cardiol 2000 Functional + organic LV mass Christenson, Tex Heart Inst J 2000 Functional Presence of coronary artery disease Tassan-Mangina Clin Cardiol 2003 Functional Peak velocity of tricuspid regurgitant jet; Indexed LV mass Moazami J Cardiac Surg 2004 Functional History of previous myocardial infarction Barreiro Circulation 2005 Functional + organic Functional MR Ruel Circulation 2006 Functional No enlarged left atrium (>5cm), no chronic AF No low preoperative peak aortic pressure gradient (< 60 mm Hg) Vanden Eynden Ann Thor Surg 2007 Functional + organic Functional (including ischaemic) MR Caballero-Borrego Eur J CT Surg 2008 Functional Presence of CAD, absence of diabetes and of PHT 17 studies Waisbren Ann Thor Surg 2008 Functional: n=10 Organic + funct: n=7 Functional No CABG MR severity, trace or mild aortic insufficiency Left atrial size < 4.5cm Congestive heart failure Unger Am J Cardiol 2008 Functional + organic MR severity Mitral coaptation height Wan JTCVS 2009 Functional Lesser preop TR, lower MR grade under anesthesia No cerebrovasc disease Lower EF AF Unger Heart 2010 Functional + organic Functional MR; absence of patient-prosthesis mismatch Matsumura Am J Cardiol 2010 Functional Lower tenting area Improvement Joo Ann Thorac Surg 2011 Functional Preoperative RV systolic pressure Functional etiology Low EF, CHF Lower grade of MR under anesthesia Less/no improvement Organic etiology Enlarged atrium Pulmonary HT
26 Postop RV reduction, ml Postoperative changes in RV (pre-post), ml Relationship between prosthetic EOA and postoperative reduction in mitral regurgitation r=0.47; p=0.003 r=0.26, p=ns r=0.47, p= Postop ERO reduction, mm ±4.0 16±6 2.6± ±8.2 p=0.02 p= Projected indexed EOA, cm 2.m N=42 with preoperative ERO 10 mm² No PPM (n=19, 45%) PPM (n=23, 55%) PPM: postop indexed AVA < 0.85 cm²/m² Unger P, Magne J, Lancellotti P. Heart 2010;96:1627
27 TAVI and MR Webb Circulation 2007 Prosthesis TA/TF Edwards TF Number of pts with MR Etiology of MR 37 NA 1 month 6 months 12 months Timing Improvement Deterioration Predictive factors for improvement 38% 42% 53% NA NA Tzikas Cath Cardiovasc Intv 2010 Gotzmann Am Heart J 2010 Durst J Heart Valve Disease 2011 Hekimian JASE 2011 De Chiara Cathet Cardiovasc Interv 2011 Samim Int J Cardiol 2011 Toggweiler JACC 2012 CoreValve 34 Org 50% 97±47 days 17% 22% Low LVEF CoreValve 34 NA 6 months 44% 21% NA Edwards TF Edwards TF+TA 35 Org 53% (Restrictive MAC) 326 patients Organic in 42-81% 60 Org 74% 7 days 1 month CoreValve 16 Org 81% 7.8 ± 5.4 months Edwards TF+TA Improvement 12-58% 30 months 34% 2% No restrictive MAC 7 days - 1yr 28% 11% LV dilatation Low EF Deterioration 0-33% Functional MR Low EF PAPS<60 mmhg No AF Valve position 12% 33% No low valve (CV) positioning Small LA size 12 Org 42% 1 month 58% 0% Functional MR Edwards 132 Org 45% 1 year 58% 1% Functional MR 40 mm Hg Ao PG No AF NA, data non available
28 Does the type of prosthesis matter? Prosthesis TA/TF Number of pts with MR Etiology of MR Improvement Deterioration Predictive factors for improvement Timing Webb Circulation 2007 Edwards TF 37 NA 38% 42% 53% NA NA 1 month 6 months 12 months Tzikas Cath Cardiovasc Intv 2010 Gotzmann Am Heart J 2010 CoreValve 34 Org 50% 17% 22% Low LVEF 97±47 days CoreValve 34 NA 44% 21% NA 6 months Durst J Heart Valve Disease 2011 Edwards TF 35 Org 53% (Restrictive MAC) 34% 2% No restrictive MAC 30 months Hekimian JASE 2011 Edwards TF+TA 60 Org 74% 28% 11% LV dilatation Low EF 7 days 1 month De Chiara Cathet Cardiovasc Interv 2011 CoreValve 16 Org 81% 12% 33% No low valve positioning 7.8 ± 5.4 months Samim Int J Cardiol 2011 Edwards TF+TA 12 Org 42% 58% 0% Functional MR 1 month Toggweiler JACC 2012 Edwards 132 Org 45% 58% 1% Functional MR 40 mm Hg Ao PG No AF 1 year NA, data non available
29 % CoreValve vs Edwards prosthesis Impact on MR? P = Improvement P < Deterioration CoreValve (n=84) Edwards (n=276) CoreValve Tzikas, Cath Cardiovasc Intv 2010 Gotzmann, Am Heart J 2010 De Chiara, Cathet Cardiovasc Interv 2011 Edwards Webb, Circulation 2007 Durst, J Heart Valve Disease 2011 Hekimian, JASE 2011 Samim, Int J Cardiol 2011 Toggweiler, JACC 2012
30 Aortic stenosis and mitral regurgitation Functional significance Prognostic value AVR affects the severity of MR Predictors of MR down-grading after AVR/TAVI? Therapeutic strategy?
31 2007 ESC Guidelines on the Management of Valvular Heart Disease «Data on multiple valve diseases are lacking and do not allow for evidence-based recommendations..» 2008 Focused Update ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease «Each case must be consider individually the committee has developed no specific recommendations.»
32 When is double-valve surgery indicated in the presence of symptomatic severe AS? when MR is severe however, Some MR improvement may be observed even if there is severe MR when is MR severe?
33 Treshold of MR severity? Ischaemic (functional) MR ERO 20 mm² (1) Organic MR ERO 40 mm² (2) frequent downgrading after AVR less frequent downgrading risk of future reoperation mm² 1. Grigioni F et al. Circulation 2001;103: Enriquez-Sarano M. et al. N Engl J Med 2005;352:875-83
34 Symptomatic Aortic Stenosis + MR Assess the ERO ERO < 20 mm² ERO mm² ERO 30 mm² Functional MR Organic MR PASP > 50 mmhg LAD > 50 mm Atrial fibrillation PPM Yes Low Operative risk+comorbidities Intermediate High No mitral valve surgery No AVR + mitral valve surgery (preferably repair) Isolated AVR Low Intermediate TAVI + MitraClip? TAVI High Surgical Risk adapted from Unger P, Rosenhek R, Lancellotti P. Heart 2011;97:272
35 Thank you for your attention!
36 If surgery is indicated because of severe MR, aortic valve replacement will be indicated if: Aortic stenosis Mild moderate severe Jet velocity (m/s) <3 3-4 >4 Mean gradient (mm Hg) < >40 AVA (cm²) > <1 (<0.6cm²/m²) Indication of AVR Level of evidence Class IIb* C Class IIa B/C Class I C *if evidence that progression may be rapid
37 Severe Mitral Regurgitation + AS ΔP, jet velocity, AVA Jet velocity <3-4m/s Mean gradient <25 mm Hg AVA >1.5 cm Jet velocity 3-4m/s Mean gradient mm Hg AVA cm² Jet velocity >4m/s Mean gradient >40 mm Hg AVA <1 cm² (<0.6 cm²/m²) ESC ACC/AHA Class III Rapid progression? Class IIb (c) Class IIa (b/c) Class I (c) No aortic valve surgery Aortic valve surgery Operative risk+comorbidities adapted from ACC/AHA and ESC Guidelines on patients with VHD
38 Severe prosthesis-patient mismatch after aortic bioprosthesis implantation according to the aortic annulus size: PAVI; stentless valve AVR; and stented valve AVR Clavel MA et al. J Am Coll Cardiol. 2009;53:1883
39 Multivariate Predictors of Reduced MR at 1-Year Follow-Up N = 132 Organic MR: 45% Multivariate Odds Ratio (95% CI) Multivariate p Value Pulmonary pressure <60 mm Hg Absence of atrial fibrillation 2.68 ( ) ( ) 0.02 Functional MR 2.61 ( ) 0.02 Mean gradient 40 mm Hg 2.71 ( ) 0.02 Toggweiler, S. et al. J Am Coll Cardiol 2012 Jun 5;59:2068
40 Prevalence of mitral regurgitation in patients undergoing isolated AVR Authors, Year N Exclusion criteria Method of MR assessment Percentage of patients with preoperative MR Tunick Am J Cardiol None Colour flow mapping 61% with mild MR Adams Am J Cardiol 1990 Tassan-Mangina Clin Cardiol 2003 Moazami J Card Surg 2004 Barreiro Circulation 2005 Ruel Circulation 2006 Caballero-Borrego Eur J Cardiothor Surg 2008 Waisbren Ann Thor Surg 2008 Wan J Thorac Cardiovasc Surg 2009 Jeong Am J Cardiol studies N = * None Pulsed wave Doppler mapping 30 Severe AR; unstable haemodynamics Arrhythmia 250 Organic mitral valve disease Previous sternotomy or mitral valve surgery 408 Concomitant bypass surgery Age > 70 y 848 Organic mitral valve disease Patients Variable++ who did not survive the operation organic MVD (6) 577 Organic mitral valve disease moderate Predominant AR AR (3) Predominant coronary artery disease Type CAD/CABG A AD; MR secondary (4) to SAM 227 Organic mitral valve disease Combined procedure (CABG) Endocarditis Right heart valve procedure Moderate or severe AR Colour flow mapping Colour flow mapping Colour flow mapping 2003 American Society of Echocardiography recommendations Colour flow and pulsed wave Doppler mapping, pulmonary vein flow Vena contracta width 4934 Concurrent or previous MVR Color flow mapping, vena contracta or PISA 384 Organic MR Ischemic heart disease Mainly qualitative or 1/2-quantitative Colour flow mapping 82% with 1+ MR 90% with mild MR 78% with mild MR 17.2% with moderate MR 12.6% with 2+ MR mild: 30-80% moderate: ±15% 26.5% with non-severe MR 74% with moderate MR 43% with mild MR 14% with moderate MR 30% with mild MR
41 Prevalence of mitral regurgitation in patients undergoing TAVI Authors, Year Webb Circulation 2007 Tzikas Cath Cardiovasc Intv 2010 Durst J Heart Valve Diss 2011 Hekimian JASE 2011 De Chiara Cath Cardiovasc Intv 2011 Number of patients MR etiology Method of MR assessment Percentage of patients with preoperative MR 50 NA NA 53% with moderate MR 79 Organic MR 50% Color flow mapping None 24% 57% with mild MR 18% with moderate MR 55 53% MAC with restriction 3% MVP 30% valve thickening 17% functional 254 Organic 68% Functional 32% Vena contracta Color flow mapping VC PISA 63% with mild-to-mod MR 43% with moderate MR 6% with severe MR None 26% 44% with 1+ MR 25% with 2+ MR 5% with 3-4+ MR 58 Organic81% Color flow mapping 72% with 0-1+ MR 22.4% with 2+ MR 5.1% with 3-4+ MR Samim 22 Organic 62,5% NA None 27% 36% with mild MR 32% with moderate MR Mainly Severe in 4% Toggweiler JACC studies N = 950 Organic 50-80% 451 Functional 56% MAC 47% NA; information not available qualitative or 1/2-quantitative ESC/AHA/ACC recommendation mild: 70-80% moderate: 20-35% Severe 5-10% 20% with moderate MR 10% with severe MR
42 Mitral RV decrease (ml/beat) N=419 EOAi 0.85 cm²/m²: 40.6% MRV decrease PPM=0 MRV decrease PPM=1 Angeloni A, et al. Circ Cardiovasc Imaging 2012;5:36
Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM
The Patient with Aortic Stenosis and Mitral Regurgitation Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM Aortic Stenosis + Mitral Regurgitation?
More informationIoannis Alexanian, MD, PhD Department of Cardiology General Hospital of Chest Diseases Sotiria Athens
MITRAL REGURGITATION IN PATIENT WITH SEVERE AORTIC VALVE STENOSIS Ioannis Alexanian, MD, PhD Department of Cardiology General Hospital of Chest Diseases Sotiria Athens I HAVE NOTHING TO DECLARE Management
More informationPrimary Mitral Regurgitation
EURO VALVE Madrid News from Valves Guidelines 2012: What s new and Why? Primary Mitral Regurgitation Luc A. Pierard, MD, PhD Professor of Medicine Head of the Department of Cardiology Heart Valve Clinic,
More informationLow Gradient Severe? AS
Low Gradient Severe? AS Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Institut Universitaire de Cardiologie et de Pneumologie de Québec / Québec Heart
More informationECHO HAWAII. Role of Stress Echo in Valvular Heart Disease. Not only ischemia! Cardiomyopathy. Prosthetic Valve. Diastolic Dysfunction
Role of Stress Echo in Valvular Heart Disease ECHO HAWAII January 15 19, 2018 Kenya Kusunose, MD, PhD, FASE Tokushima University Hospital Japan Not only ischemia! Cardiomyopathy Prosthetic Valve Diastolic
More informationProsthetic valve dysfunction: stenosis or regurgitation
Prosthetic valve dysfunction: stenosis or regurgitation Jean G. Dumesnil MD, FRCP(C), FACC, FASE(Hon) Quebec Heart and Lung Institute, Québec, Québec No disclosures Possible Causes of High Gradients in
More informationHow to assess ischaemic MR?
ESC 2012 How to assess ischaemic MR? Luc A. Pierard, MD, PhD, FESC, FACC Professor of Medicine Head, Department of Cardiology University Hospital Sart Tilman, Liège ESC 2012 No conflict of interest Luc
More informationValvular Guidelines: The Past, the Present, the Future
Valvular Guidelines: The Past, the Present, the Future Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital Editor-in-Chief,
More informationSpotlight on Valvular Heart Disease Guidelines
Spotlight on Valvular Heart Disease Guidelines Aortic Valve Disease Raphael Rosenhek Department of Cardiology Medical University of Vienna Palermo, April 26 th 2018 1998 2002 2006 2007 2008 2012 2014 2017
More informationGuidelines in perspective?
EuroValve 2016 Challenges in the management Secondary MR Guidelines in perspective? Luc A. Pierard, MD, PhD Professor of Medicine Head of the Department of Cardiology, Liège, Belgium Heart Valve Clinic,
More informationRole of Stress Echo in Valvular Heart Disease. Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan
Role of Stress Echo in Valvular Heart Disease Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan Exercise echocardiography Dobutamine echocardiography Usefulness of exercise echo
More informationClinical Outcome of Tricuspid Regurgitation. David Messika-Zeitoun
Clinical Outcome of Tricuspid Regurgitation David Messika-Zeitoun I have financial relationships to disclose Consultant for: Edwards, Symetis and Valtech Tricuspid Regurgitation is a Common Finding Tricuspid
More informationHow does Pulmonary Hypertension Affect the Decision to Intervene in Mitral Valve Disease? NO DISCLOSURE
How does Pulmonary Hypertension Affect the Decision to Intervene in Mitral Valve Disease? Prof. Patrizio LANCELLOTTI, MD, PhD GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège, CHU
More informationValvular Regurgitation: Can We Do Better Than Colour Doppler?
Valvular Regurgitation: Can We Do Better Than Colour Doppler? A/Prof David Prior St Vincent s Hospital Melbourne Sports Cardiology Valvular Regurgitation Valve regurgitation volume loads the ventricles
More information«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer
«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Université LAVAL
More informationPercutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives. Bernard Iung Bichat Hospital, Paris
Percutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives Bernard Iung Bichat Hospital, Paris Euro Heart Survey on Valvular Diseases 3547 Patients with Native Valve Disease n= 1250 1000
More informationProsthesis-Patient Mismatch or Prosthetic Valve Stenosis?
EuroValves 2015, Nice Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE FESC Canada Research Chair in Valvular Heart Diseases Université LAVAL Disclosure
More informationThe difficult patient with mitral regurgitation
Clinical pathways The difficult patient with mitral regurgitation Stress echo can be the best tool Challenging cases Maria João Andrade, Lisbon PT Management of Severe Chronic Organic MR Echo Exercise
More informationTAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central
TAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central Michigan University 1 Disclosure Chiesi Pharma- Consultant
More informationValvular Heart Disease
Valvular Heart Disease B K Singh, MD, FACC Disclosures: None 1 CARDIAC CYCLE S2 S2=A2P2 S1=M1T1 S4 S1 S3 2 JVP Carotid S1 Slitting of S2 S3 S4 Ejection click Opening snap Dynamic Auscultation What is the
More informationNatural History and Echo Evaluation of Aortic Stenosis
Natural History and Echo Evaluation of Aortic Stenosis Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM AORTIC STENOSIS First valvular disease
More informationThe Changing Epidemiology of Valvular Heart Disease: Implications for Interventional Treatment Alternatives. Martin B. Leon, MD
The Changing Epidemiology of Valvular Heart Disease: Implications for Interventional Treatment Alternatives Martin B. Leon, MD Columbia University Medical Center Cardiovascular Research Foundation New
More informationIschemic Mitral Regurgitation
Ischemic Mitral Regurgitation Jean-Louis J. Vanoverschelde, MD, PhD Université catholique de Louvain Brussels, Belgium Definition Ischemic mitral regurgitation is mitral regurgitation due to complications
More informationPARAVALVULAR LEAK POST TAVR. Elements of Follow-up Post TAVR
PARAVALVULAR LEAK POST TAVR David S Rubenson MD FACC FASE Founding Director, Cardiac Non-Invasive Laboratory Scripps Clinic Medical Group number 1 Elements of Follow-up Post TAVR JACC CV Imag 2016;9:193
More informationEchocardiographic changes after aortic valve replacement: Does the failure rate of mitral valve change? Original Article
Echocardiographic changes after aortic valve replacement: Does the failure rate of mitral valve change? Abstract Arezoo Khosravi (1), Hadi Sheykhloo (2), Reza Karbasi-Afshar (1), Amin Saburi (3) Original
More informationExercise Testing/Echocardiography in Asymptomatic AS
Exercise Testing/Echocardiography in Asymptomatic AS Raluca Dulgheru, MD Heart Valve Clinic, University of Liège, CHU Sart Tilman, BELGIUM Disclosure related to this presentation: None VALVULAR HEART DISEASE
More informationΧειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας
Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Dr Χρήστος ΑΛΕΞΙΟΥ MD, PhD, FRCS(Glasgow), FRCS(CTh), CCST(UK) Consultant Cardiothoracic Surgeon Normal Mitral Valve Function Mitral Regurgitation
More informationExercise PHT in valvular heart disease. Julien Magne CHU Limoges, France
Exercise PHT in valvular heart disease Julien Magne CHU Limoges, France Faculty disclosure Julien Magne I disclose the following financial relationships: I have no financial relationships to disclose.
More informationCulprit vs Multivalve Transcatheter Intervention
Culprit vs Multivalve Transcatheter Intervention Howard C. Herrmann, MD, FACC, MSCAI John Bryfogle Professor of Cardiovascular Medicine and Surgery Health System Director for Interventional Cardiology
More informationValvular Intervention
Valvular Intervention Outline Introduction Aortic Stenosis Mitral Regurgitation Conclusion Calcific Aortic Stenosis Deformed Eccentric Calcified Nodular Rigid HOSTILE TARGET difficult to displace prone
More informationPrimary Mitral Valve Disease: Natural History & Triggers for Intervention ACC Latin American Conference 2017
Disclosures: GE stock, Primary Mitral Valve Disease: Natural History & Triggers for Intervention ACC Latin American Conference 2017 Athena Poppas, MD FACC Past ACC Scientific Sessions Chair, ACC Board
More informationReshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid
Reshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid Patient records 76 y.o. male Hypertension. Dyslipidemia. OPLD. Smoked in the past. Diabetes
More informationA Surgeon s Perspective Guidelines for the Management of Patients with Valvular Heart Disease Adapted from the 2006 ACC/AHA Guideline Revision
A Surgeon s Perspective Guidelines for the Management of Patients with Valvular Heart Disease Adapted from the 2006 ACC/AHA Guideline Revision Prof. Pino Fundarò, MD Niguarda Hospital Milan, Italy Introduction
More informationLoad and Function - Valvular Heart Disease. Tom Marwick, Cardiovascular Imaging Cleveland Clinic
Load and Function - Valvular Heart Disease Tom Marwick, Cardiovascular Imaging Cleveland Clinic Indications for surgery in common valve lesions Risks Operative mortality Failed repair - to MVR Operative
More informationFunctional Mitral Regurgitation
Club 35 - The best in heart valve disease - Functional Mitral Regurgitation Steven Droogmans, MD, PhD UZ Brussel, Jette, Belgium 08-12-2011 Euroecho & other Imaging Modalities 2011 No conflicts of interest
More informationHow to Avoid Prosthesis-Patient Mismatch
How to Avoid Prosthesis-Patient Mismatch Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE, FESC Canada Research Chair in Valvular Heart Diseases INSTITUT UNIVERSITAIRE DE CARDIOLOGIE ET DE PNEUMOLOGIE DE QUÉBEC
More informationI have financial relationships to disclose Honoraria from: Edwards
I have financial relationships to disclose Honoraria from: Edwards Mitral Valve Annuloplasty in Ischemic Mitral regurgitation Jean François Avierinos Hôpital Timone Marseille August 28, 2012 Ischemic MR
More informationTRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH
TRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH Available systems: Edwards (TA and TF) and Core valve. INTRODUCTION 3 4% 0f > 65 y. 30 40% of elderly denied surgery,.
More informationDisclosures. ESC Munich 2012 Bernard Iung, MD Consultancy: Abbott Boehringer Ingelheim Bayer Servier Valtech
Disclosures ESC Munich 2012 Bernard Iung, MD Consultancy: Abbott Boehringer Ingelheim Bayer Servier Valtech Speaker s fee Edwards Lifesciences Sanofi-Aventis Decision Making in Patients with Multivalvular
More informationAsymptomatic Valvular Disease:
Asymptomatic Valvular Disease: Can Echocardiography Help You Decide When to Intervene? Neil J. Weissman, MD MedStar Health Research Inst at MedStar Washington Hospital Center & Professor of Medicine Georgetown
More informationCandice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada
PVR Following Repair of TOF Now? When? Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada Late Complications after TOF repair Repair will be necessary
More informationAS with reduced LV ejection fraction: Contractile reserve should be systematically assessed: PRO
AS with reduced LV ejection fraction: Contractile reserve should be systematically assessed: PRO Jean-Luc MONIN, MD, PhD Henri Mondor University Hospital Créteil, FRANCE Potential conflicts of interest
More informationManagement of Difficult Aortic Root, Old and New solutions
Management of Difficult Aortic Root, Old and New solutions Hani K. Najm MD, Msc, FRCSC,, FACC, FESC Chairman, Pediatric and Congenital Heart Surgery Cleveland Clinic Conflict of Interest None Difficult
More informationLow Gradient Severe AS: Who Qualifies for TAVR? Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor
Low Gradient Severe AS: Who Qualifies for TAVR? Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central Michigan University
More informationManagement of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France
Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Background Aortic stenosis (AS) is the most frequent valve disease among referred
More informationTAVR in patients with. End-Stage CKD or in Renal Replacement Therapy:
TAVR in patients with End-Stage CKD or in Renal Replacement Therapy: Special Considerations and Prevention of early Valve Failure Antonios Chalapas, MD, PhD, FESC THV & Hygeia Hospital Heart Team Athens,
More informationLate secondary TR after left sided heart disease correction: is it predictibale and preventable
Late secondary TR after left sided heart disease correction: is it predictibale and preventable Gilles D. Dreyfus Professor of Cardiothoracic surgery Nath J, et al. JACC 2004 PREDICT Incidence of secondary
More informationMichigan Society of Echocardiography 30 th Year Jubilee
Michigan Society of Echocardiography 30 th Year Jubilee Stress Echocardiography in Valvular Heart Disease Moving Beyond CAD Karthik Ananthasubramaniam, MD FRCP (Glas) FACC FASE FASNC Associate Professor
More informationMitral Valve prolapse: What s new? Which indications of early surgery? Input of new 2017 ESC/EACTS guidelines. Christophe Tribouilloy Amiens, France
Mitral Valve prolapse: What s new? Which indications of early surgery? Input of new 2017 ESC/EACTS guidelines Christophe Tribouilloy Amiens, France I have no financial relationships to disclose related
More information2/15/2018 DISCLOSURES OBJECTIVES. Consultant for BioSense Webster, a J&J Co. Aortic stenosis background. Short history of TAVR
TRANSCATHETER AORTIC VALVE REPLACEMENT IN 2018: IS IT NOW THE STANDARD OF CARE? 22 ND ANNUAL COASTAL CARDIAC & VASCULAR CONFERENCE FEBRUARY 17, 2018 R. David Anderson, MD, MS, FACC, FSCAI Professor of
More informationValve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal
Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal I have nothing to disclose. Wide Spectrum Stable vs Decompensated NYHA II IV? Ejection
More informationChronic Primary Mitral Regurgitation
Chronic Primary Mitral Regurgitation The Case For Early Surgical Intervention William K. Freeman, MD, FACC, FASE DISCLOSURES Relevant Financial Relationship(s) None Off Label Usage None Watchful Waiting......
More informationTAVR: Intermediate Risk Patients
TAVR: Intermediate Risk Patients Oscar A. Mendiz.MD.FACC.FSCAI Director Cardiology & Cardiovascular Institute (ICyCC) Chief Interventional Cardiology Department Board of Directors Hospital & Favaloro University
More informationEchocardiographic variables associated with mitral regurgitation after aortic valve replacement for aortic valve stenosis
The Egyptian Heart Journal (2013) 65, 135 139 Egyptian Society of Cardiology The Egyptian Heart Journal www.elsevier.com/locate/ehj www.sciencedirect.com ORIGINAL ARTICLE Echocardiographic variables associated
More informationTAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair?
TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? Elaine E. Tseng, MD and Marlene Grenon, MD Department of Surgery Divisions of Adult Cardiothoracic and Vascular and Endovascular
More informationMarti McCulloch, BS, MBA, RDCS, FASE Houston, Texas
Marti McCulloch, BS, MBA, RDCS, FASE Houston, Texas Mitral Regurgitation What to Expect Review Specific Signs of Severity Supportive Signs of Severity Qualitative Parameters Structural Doppler Quantitative
More informationTAVR: Echo Measurements Pre, Post And Intra Procedure
2017 ASE Florida, Orlando, FL October 10, 2017 8:00 8:25 AM 25 min TAVR: Echo Measurements Pre, Post And Intra Procedure Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate
More informationIndication, Timing, Assessment and Update on TAVI
Indication, Timing, Assessment and Update on TAVI Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Starr- Edwards Mechanical
More informationCIPG Transcatheter Aortic Valve Replacement- When Is Less, More?
CIPG 2013 Transcatheter Aortic Valve Replacement- When Is Less, More? James D. Rossen, M.D. Professor of Medicine and Neurosurgery Director, Cardiac Catheterization Laboratory and Interventional Cardiology
More informationDisclosures Rebecca T. Hahn, MD, FASE
The New ASE Guidelines for Native Valvular Regurgitation Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR (With caveats and comments from R. Hahn) William A. Zoghbi MD, FASE, MACC Professor
More informationLV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital
LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload
More informationIndicator Mild Moderate Severe
Indicator Mild Moderate Severe Jet velocity (m/s) 2.0-2.9 3.0-3.9 4.0 Mean gradient (mmhg) < 20 20-39 40 Valve area (cm 2 ) 1.0 Valve area index (cm 2 /m 2 ) 0.6 1 Abnormal AV with Reduced Systolic Opening
More informationAortic Valve Replacement Improves Outcome in Patients with Preserved Ejection Fraction: PRO!
ESC 2011, Paris Controversies in Low-Flow, Low-Gradient Aortic Stenosis Aortic Valve Replacement Improves Outcome in Patients with Preserved Ejection Fraction: PRO! Philippe Pibarot, DVM, PhD, FACC, FAHA,
More informationTREATMENT OF MITRAL REGURGITATION RAJA NAZIR FACC
TREATMENT OF MITRAL REGURGITATION RAJA NAZIR FACC NATURAL HISTORY OF MITRAL REGURGITATION Abdallah El Sabbagh et al. JIMG 2018;11:628-643 TREATMENT OPTIONS SURGERY REPAIR REPLACEMENT PERCUTANEOUS INTERVENTIONS
More informationObjectives. Considerations in management of multivalvular disease. Case Discussions. A Systematic Approach to Multivalve Disease.
A Systematic Approach to Multivalve Disease James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School of Medicine, Northwestern
More informationASE Guidelines on Aortic Regurgitation What Do I Measure? Case Studies
ASE Guidelines on Aortic Regurgitation What Do I Measure? Case Studies Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR William A. Zoghbi MD, FASE, MACC Professor and Chairman, Department
More informationHIGHLIGHT SESSION. Imaging. J. L. Zamorano Gomez (Madrid, ES) Disclosures: Speaker Philips
Imaging. J. L. Zamorano Gomez (Madrid, ES) Disclosures: Speaker Philips Agenda ECHO Diagnosis & Prognosis : Functional MR Severity Aortic Stenosis CT How to select pts for TAVI Adding prognostic info to
More informationThe best in heart valve disease Aortic valve stenosis
The best in heart valve disease Aortic valve stenosis Marie Moonen, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, BELGIUM My declaration of interest : I have nothing to declare Prevalence
More informationPercutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat
Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat Innovative Procedures, Devices & State of the Art Care for Arrhythmias, Heart Failure & Structural Heart Disease October 8-10,
More informationStress Testing in Valvular Disease
2017 ASE Florida Orlando, FL October 10, 2017 2:40 2:50 PM 10 min Grand Harbor Ballroom South Stress Testing in Valvular Disease Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate
More informationSevere left ventricular dysfunction and valvular heart disease: should we operate?
Severe left ventricular dysfunction and valvular heart disease: should we operate? Laurie SOULAT DUFOUR Hôpital Saint Antoine Service de cardiologie Pr A. COHEN JESFC 16 janvier 2016 Disclosure : No conflict
More informationExercise Pulmonary Hypertension predicts the Occurrence of Symptoms in Asymptomatic Degenerative Mitral Regurgitation
Exercise Pulmonary Hypertension predicts the Occurrence of Symptoms in Asymptomatic Degenerative Mitral Regurgitation Julien Magne, PhD, Kim O Connor, MD, Giuseppe Romano, MD, Marie Moonen, MD, Luc A.
More informationEchocardiographic evaluation of mitral stenosis
Echocardiographic evaluation of mitral stenosis Euroecho 2011 Philippe Unger, MD, FESC Erasme Hospital, ULB, Brussels, Belgium I have nothing to declare EuroHeart Survey Etiology of single native left-sided
More informationTAVR IN INTERMEDIATE-RISK PATIENTS
TAVR IN INTERMEDIATE-RISK PATIENTS K. Lampropoulos MD, PhD, FESC, MEAPCI Interventional Cardiologist Evangelismos General Hospital The Burden of Valve Disease Prevalence Survival NATURAL HISTORY OF AS
More informationComprehensive Echo Assessment of Aortic Stenosis
Comprehensive Echo Assessment of Aortic Stenosis Smonporn Boonyaratavej, MD, MSc King Chulalongkorn Memorial Hospital Bangkok, Thailand Management of Valvular AS Medical and interventional approaches to
More informationAortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV?
Aortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV? Samin K Sharma, MD, FACC, FSCAI Director Clinical & Interventional
More informationNew imaging modalities for assessment of TAVI procedure and results. R Dulgheru, MD Heart Valve Clinic CHU, Liege
New imaging modalities for assessment of TAVI procedure and results R Dulgheru, MD Heart Valve Clinic CHU, Liege Disclosure of Interest I, Raluca Dulgheru, DO NOT HAVE a financial interest/arrangement
More informationSONOGRAPHER & NURSE LED VALVE CLINICS
SONOGRAPHER & NURSE LED VALVE CLINICS Frequency of visits and alerts AORTIC STENOSIS V max > 4.0 m/s or EOA < 1.0 cm 2 V max 3.5 4.0 m/s + Ca+ V max 3.0 4.0 m/s or EOA 1.0-1.5 cm 2 V max 2.5 3.0 m/s every
More informationSténose aortique à Bas Débit et Bas Gradient
3.6 m/s Sténose aortique à Bas Débit et Bas Gradient Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Doctorate Honoris Causa, Université de Liège Institut
More informationImaging MV. Jeroen J. Bax Leiden University Medical Center The Netherlands Davos, feb 2015
Imaging MV Jeroen J. Bax Leiden University Medical Center The Netherlands Davos, feb 2015 MV/MR: information needed on.. 1. MV anatomy 2. MR etiology - primary vs secondary 3. MR severity quantification
More informationMeasuring the risk in valve patients Lessons learnt from the TAVI story? Bernard Iung Bichat Hospital, Paris, France
Measuring the risk in valve patients Lessons learnt from the TAVI story? Bernard Iung Bichat Hospital, Paris, France Faculty disclosure Bernard Iung I disclose the following financial relationships: Consultant
More informationΕπιδιόπθωζη μιηποειδικήρ ζςζκεςήρ ζε ππόπηωζη ή πήξη γλωσίνων. Βαζίλειορ Σασπεκίδηρ Επιμεληηήρ Β Καπδιολογίαρ Γ.Ν. Παπαγεωπγίος
Επιδιόπθωζη μιηποειδικήρ ζςζκεςήρ ζε ππόπηωζη ή πήξη γλωσίνων Βαζίλειορ Σασπεκίδηρ Επιμεληηήρ Β Καπδιολογίαρ Γ.Ν. Παπαγεωπγίος MV anatomy Otto C. NEJM 2001 Leaflets anatomy 2% of population Etiology Terminology
More informationWhat are the best diagnostic tools to quantify aortic regurgitation?
What are the best diagnostic tools to quantify aortic regurgitation? Agnès Pasquet, MD, PhD Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université catholique de Louvain
More informationEVALUATION OF CHRONIC MITRAL REGURGITATION: ASSESSING MECHANISMS AND QUANTIFYING SEVERITY 2018 STRUCTURAL HEART DISEASE CONFERENCE June 1, 2018
1 EVALUATION OF CHRONIC MITRAL REGURGITATION: ASSESSING MECHANISMS AND QUANTIFYING SEVERITY 2018 STRUCTURAL HEART DISEASE CONFERENCE June 1, 2018 David A. Orsinelli, MD, FACC, FASE Professor, Internal
More informationReverse left atrium and left ventricle remodeling after aortic valve interventions
Reverse left atrium and left ventricle remodeling after aortic valve interventions Alexandra Gonçalves, Cristina Gavina, Carlos Almeria, Pedro Marcos-Alberca, Gisela Feltes, Rosanna Hernández-Antolín,
More informationDiastolic Heart Function: Applying the New Guidelines Case Studies
Diastolic Heart Function: Applying the New Guidelines Case Studies Mitral Regurgitation The New ASE William Guidelines: A. Zoghbi Role MD, of FASE, 2D/3D MACCand CMR Professor and Chairman, Department
More informationSecondary Mitral Regurgitation: When Should We Intervene?
/19/17 Secondary Mitral Regurgitation: When Should We Intervene? Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital
More informationAdvanced Evaluation of Left Ventricular Function in Degenerative MR. Dr Julien Magne, PhD University of Liege, CHU Sart Tilman, Liege, Belgium
Advanced Evaluation of Left Ventricular Function in Degenerative MR Dr Julien Magne, PhD University of Liege, CHU Sart Tilman, Liege, Belgium Conflict of Interest Disclosure None Case Clinical data Previous
More informationManaging the Low Output Low Gradient Aortic Stenosis Patient
Managing the Low Output Low Gradient Aortic Stenosis Patient R A Nishimura MD Judd and Mary Leighton Professor of CV Mayo Clinic No disclosures Valvular Stenosis Severity of Aortic Stenosis Mean gradient
More informationDoes Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?
Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles
More informationTranscatheter Aortic Valve Implantation. SSVQ November 23, 2012 Centre Mont-Royal 15:40
Transcatheter Aortic Valve Implantation SSVQ November 23, 2012 Centre Mont-Royal 15:40 Nicolo Piazza MD, PhD, FRCPC, FESC, FACC McGill University Health Center German Heart Center Munich 1 First-in-Human
More informationTricuspid and Pulmonary Valve Disease
Tricuspid and Pulmonary Valve Disease Lawrence Rudski MD FRCPC FACC FASE Professor of Medicine Director, Division of Cardiology Jewish General Hospital McGill University Right Sided Failure Edema Gut congestion
More informationLes valvulopathies en sourdine: la valve mitrale Quoi faire devant une régurgitation mitrale sévère asymptomatique de type dégénérative?
Réunion d automne de la SSC à Lucerne le 24.11.2011 Incertitudes dans le travail cardiologique quotidien Les valvulopathies en sourdine: la valve mitrale Quoi faire devant une régurgitation mitrale sévère
More informationQuality Outcomes Mitral Valve Repair
Quality Outcomes Mitral Valve Repair Moving Beyond Reoperation Rakesh M. Suri, D.Phil. Professor of Surgery 2015 MFMER 3431548-1 Disclosure Mayo Clinic Division of Cardiovascular Surgery Research funding
More informationProsthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis
Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis George L. Zorn, III On Behalf of the CoreValve US Clinical Investigators
More informationChoose the grading of diastolic function in 82 yo woman
Question #1 Choose the grading of diastolic function in 82 yo woman E= 80 cm/s A= 70 cm/s LAVI < 34 ml/m 2 1= Grade 1 2= Grade 2 3= Grade 3 4= Normal 5= Indeterminate 2018 MFMER 3712003-1 Choose the grading
More informationESC / EACTS new valvular guidelines- Update
ESC / EACTS new valvular guidelines- Update Yaron Shapira, MD The Dan Sheingarten echocardiography & valve clinic Rabin Medical Center, Beilinson Hospital, Petah-Tiqva Tel-Aviv University ESC valve guidelines
More informationTAVR 2018: TAVR has high clinical efficacy according to baseline patient risk! ii. Con
TAVR 2018: TAVR has high clinical efficacy according to baseline patient risk! ii. Con Dimitrios C. Angouras, MD, FETCS Associate Professor of Cardiac Surgery National and Kapodistrian University of Athens,
More informationWhat echo measurements are key prior to MitraClip?
APHP CHU Bichat - Claude Bernard What echo measurements are key prior to MitraClip? Eric Brochet,MD Cardiology Department Hopital Bichat Paris France No disclosure Conflict of interest Case 69 y.o man
More informationOutline 9/17/2016. Advances in Percutaneous Mitral Valve Repair and Replacement. Scope of the Problem and Guidelines
Advances in Percutaneous Mitral Valve Repair and Replacement Scott M Lilly MD PhD, Interventional Cardiology The Ohio State University Contemporary Multidisciplinary Cardiovascular Conference Orlando,
More information