Cases of Abnormal Prosthetic Valves
|
|
|
- Henry Myles McCarthy
- 6 years ago
- Views:
Transcription
1 Cases of Abnormal Prosthetic Valves Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echcoardiography Associate Director, Cardiology Fellowship Mayo Clinic, Rochester,
2 DISCLOSURE Relevant Financial Relationship(s) None Off Label Usage None
3 Huffnagel Artificial Valve At the annual meeting of the AHA in California (late 1960 s), a patient who had received the Huffnagel artificial valve was being questioned. He was asked the usual question by a member of the audience, i.e. if the loud heart sounds bothered him. He replied, No. Then after a second thought, he said, Well occasionally they do. I like to play poker and when I get an unusually good hand, the sounds get louder and faster, and gives me away.
4 30 yo Woman With Ebstein s Anomaly 2009 TVR, MV repair 2010 Endocarditis (S. aureus) Redo MVR (St. Jude Epic) 2012 Worsening fatigue, dyspnea Physical Exam HR 77 BPM, BP 110/76 mmhg, Afebrile JVP at earlobe sitting upright, prominent V-wave Heart: RRR, S4, faint systolic murmur + diastolic rumble at LLSB. Faint diastolic rumble at the apex Lungs: clear Abdomen: Shifting dullness Extremities: 1+ edema
5 Mitral Prosthesis Diastolic mean gradient: 8 mmhg (HR: 69 BPM) Blood cultures negative
6 What would you recommend? 1. Redo surgery (MVR) 2. Valve-in-valve mitral 3. Fibrinolytic therapy 4. Warfarin
7 Bioprosthetic Valve Thrombosis: Diagnosis Challenging TTE: no set criteria Increased gradients Thickened cusps, thrombus TEE Soft echodensity in cusps CT
8 Bioprosthetic Valve Thrombosis Mayo Clinic Experience
9
10 Misconceptions in BPVT How good was TTE? Abnormal findings: all patients Possibility of BPVT: 6 of 32 BPVT not suspected: 8 of 15 undergoing surgery TEE Thrombus seen in all mitral / tricuspid Challenging imaging for aortic BPV; thrombus described in 9/12 patients
11 Misconceptions in BPVT Peak incidence second year Longest interval: 6.5 years EJCTS 2014
12 Misconceptions in BPVT EJCTS 2014 VKA as effective as surgery / lytics
13 Our patient: One Month VKA Diastolic mean gradient: 3 mmhg (HR 66 BPM)
14
15 BPVT: Mayo Surgical Experience All bioprosthetic re-operations BPVT (11% of all reoperations) 92 structural failure (2:1 for age, gender, prosthetic position, and year of implantation) Egbe et al. JACC 2015.
16 Egbe et al. JACC 2015.
17 Proposed Echo Criteria 1. Increased gradient > 50% over baseline, especially within first 5 years post-implant 2. Thickened, non-calcified leaflets 3. Restricted leaflet mobility All 3 parameters: 72% sensitivity, 90% specificity for BPVT Egbe et al. JACC 2015.
18 Bioprosthetic Valve Thrombosis TAVR: A Bigger Problem?
19
20 TOTAL STUDY PATIENT 187 Symptomatic TAVR-related thrombosis is rare (<1%) Makkar et al, NEJM 2015
21 CT reconstruction Portico TAV Corresponding TEE Makkar et al, NEJM 2015
22 BPVT: Take Home Points BPVT diagnosis is challenging What we know: BPVT may occur late after implantation TTE increased gradient, may not show mechanism When to suspect: BPV gradient > 50% over baseline, restricted cusp mobility, thickened leaflets TEE/CT when in doubt
23 Case: 58 Year-Old Woman Progressive Dyspnea (NYHA III) Rheumatic heart disease 2010 Medtronic Mosaic (21mm) AVR MV Repair (27mm Duran ring) Obesity BNP not elevated
24
25
26 AV Prosthetic Gradient
27 The gradient across the prosthesis most likely reflects: A. Patient-prosthesis mismatch B. Prosthetic obstruction C. Normal function for this prosthesis D. Pressure recovery E. Cannot tell; need more information
28 Normal Valve-Specific Parameters
29 The Differential Diagnosis Elevated Prosthetic Aortic Valve Gradient Obstruction Dysfunction, thrombus, vegetation, pannus, degeneration Patient-prosthesis mismatch EOA too small for body size High output state Pressure Recovery
30 Interpretation of Elevated Aortic PV Gradients Doppler parameter Expected* Stenosis PPM High Output Pressure Recovery Gradient (mmhg) 14 ± 5 High High High High *Prosthesis-specific: Medtronic Mosaic 21mm Slide adapted from Darryl Burstow, M.D.
31 Ejection Time (ET) = 331 msec Acceleration Time (AT) = 88 msec AT / ET = 0.27
32 AT = 88 msec AT / ET = 0.27 These AV systolic time intervals are most consistent with a: A. Obstructed prosthesis B. Normal prosthesis C. I have no idea
33 Acceleration Time and Ejection Time Ben Zekry S, JACC Imaging 2011
34 Interpretation of Elevated Aortic PV Gradients Doppler parameter Gradient (mmhg) Accel Time (msec) Expected* Stenosis PPM High Output Pressure Recovery 14 ± 5 High High High High 100 > AT / ET 0.37 > *Prosthesis-specific: Medtronic Mosaic 21mm Slide adapted from Darryl Burstow, M.D.
35
36 Dimensionless Index Mean Gradient = 56 mmhg LVSVI = 54 cc / m 2 (normal 32-58) Effective Orifice Area (EOA) = 0.97 cm 2 EOA Index = 0.57 cm 2 / m 2 (BSA 1.7 m 2 ) Dimensionless Index (DI) = 0.28
37 What is the most likely cause of the elevated gradient in this case? A. Patient-prosthesis mismatch B. Prosthetic obstruction C. High output state D. Pressure recovery E. Need more information
38 Interpretation of Elevated Aortic PV Gradients Doppler parameter Expected* Stenosis PPM High Output Pressure Recovery Gradient (mmhg) Accel Time (msec) 14 ± 5 High High High High 100 > AT / ET 0.37 > Abn Leaflet Motion No Yes No No No EOA (cm 2 ) 1.4 ± 0.4 Low Expected Expected Varies EOA Index (cm 2 /m 2 ) > 0.85 Low Low > 0.85 Varies DVI > > 0.25 >0.25 Varies *Prosthesis-specific: Medtronic Mosaic 21mm Slide adapted from Darryl Burstow, M.D.
39 Interpretation of Elevated Aortic PV Gradients Doppler parameter Expected* Stenosis PPM High Output Pressure Recovery Gradient (mmhg) Accel Time (msec) 14 ± 5 High High High High 100 > AT / ET 0.37 > Abn Leaflet Motion No Yes No No No EOA (cm 2 ) 1.4 ± 0.4 Low Expected Expected Varies EOA Index (cm 2 /m 2 ) > 0.85 Low Low > 0.85 Varies DVI > > 0.25 >0.25 Varies in EOA & DVI from baseline *Prosthesis-specific: Medtronic Mosaic 21mm No Yes No No No Slide adapted from Darryl Burstow, M.D.
40 Left Ventricle and Aorta Mean Gradient: 26 mmhg
41 Surgical Consultation -AVR not advised -Medical Rx Mean Gradient = 56 mmhg Mean Gradient: 26 mmhg
42 Sinotubular Junction Diameter: 2.1 cm
43 JACC 41(3) 435, 2003 Energy loss coefficient J Am Soc Echocardiogr 2008
44 Take Home Points Use Doppler data to identify the cause for a high prosthetic AV gradient (remember AT and AT/ET) Pressure recovery may occasionally lead to significant Doppler overestimate of cath gradient Pressure recovery is most likely when the aorta is 3cm or in bileaflet mechanical prostheses (19 or 21mm) Correct for pressure recovery with the Energy Loss Index; this may improve risk stratification in AS
45 For a Patient with Mechanical Mitral Prosthesis, Which of the Following is NOT a sign of Significant Regurgitation? 1. Mitral E velocity 2.3 m/sec 2. Mitral T 1/2 150 msec 3. Mitral diastolic mean gradient 10 mmhg 4. IVRT 60 msec Question 5. MV prosthesis TVI / LVOT TVI ratio 2.6
46 Doppler Clues to Severe Mechanical MVR Regurgitation Mitral E velocity 2.0 m/sec Increased prosthesis mean gradient Normal pressure half-time Decreased IVRT Dense MR CW velocity profile
47
48 Mitral St. Jude Medical Prosthesis E=2.9 m/s CW Doppler t/2=55 msec IVRT=55 msec Severe Periprosthetic Regurgitation
49 Mechanical MVR
50 Mechanical Prosthetic Mitral Valve Function 134 pt with mechanical mitral prostheses TTE and TEE within 3±5 days 73 normal valves 21 obstructed valves 40 regurgitant valves
51 Mechanical Prosthetic Mitral Valve Dysfunction Sens Spec PPV NPV Doppler index (%) (%) (%) (%) E 1.9 m/sec VTI PMV /VTI LVO PHT 130 msec Fernandes V: Am J Cardiol 89, 3/15/02 CP
52 Mechanical MVR with Gradient Increased T1/2 Normal T1/2 Obstructed Significant MR or High Output Prosthesis TVI / LVOT TVI ratio > 2.2
53 Case 53 year old female Hx of CABG, Redo CABG & ST Jude MVR CHF (LV EF 30%) NYHA class II Chronic Atrial Fibrillation Coumadin held for colonoscopy No LMWH bridging! Sudden onset severe dyspnea SBP 85 mmhg Muffled S1 Diastolic murmur
54 No Change in Baseline EKG INR 1.7 CXR Cardiomegaly Pulmonary Edema
55 Emergent TEE Mean Gradient 20 mmhg
56 Severe LV Systolic Dysfunction
57 Cardiac Cath Total Occlusion of LAD, LCx, and RCA
58 Only One Patent Graft Significant Collaterals
59 What would you recommend now? 1. Immediate CT Surgery 2. Thrombolysis 3. Heparin and Prayer Can TEE help decide?
60 PRO-TEE Registry n = 107 Tong, A. T. et al. J Am Coll Cardiol 2004;43:77-84
61 PRO-TEE Registry Tong, A. T. et al. J Am Coll Cardiol 2004;43:77-84
62 Follow-up TEE After Thrombolysis
63 Follow-up at 1 year: NYHA Class III-IV Mean Gradient 9 mmhg (INR )
64 More Follow-up Worsening angina in addition to HF Inferolateral and anterior ischemia on vasodilator stress testing Placed on Plavix in anticipation of cardiac cath & possible PTCA/Stent Known single patent SVG to LCx All native vessels occluded proximally but LAD and RCA filled via collaterals Not candidate for 3 rd CT surgery Not candidate for Heart Transplant
65 Sudden Onset Improvement in Symptoms TTE Performed Mean Gradient 4 mmhg Another Miraculous CURE
66 Prosthetic Valve Thrombosis: Medical Therapy Recommendations COR LOE Fibrinolytic therapy is reasonable for patients with a thrombosed left-sided prosthetic heart valve, recent onset (<14 days) of NYHA class I IIa B to II symptoms, and a small thrombus Fibrinolytic therapy is reasonable for thrombosed right-sided prosthetic heart IIa B Nishimura RA et al. Circulation Jun 10;129(23):e
67 Prosthetic Valve Thrombosis: Intervention Recommendations COR LOE Emergency surgery is recommended for patients with a thrombosed left-sided prosthetic heart valve with NYHA class III to IV I B symptoms Emergency surgery is reasonable for patients with a thrombosed left-sided prosthetic heart valve with a mobile or large thrombus (>0.8 cm 2 ) IIa C Nishimura RA et al. Circulation Jun 10;129(23):e
68 Evaluation and Management of Suspected Prosthetic Valve Thrombosis Suspected Prosthetic Valve Thrombosis Class I Class IIa TTE to evaluate hemodynamic severity (I) CT or fluoroscopy to evaluate valve motion (IIa) Left-sided prosthetic valve thrombosis Right-sided prosthetic valve thrombosis TEE for thrombus size (I) NYHA class III-IV symptoms Mobile or large ( 0.8 cm 2 ) thrombus Recent onset (<14 d) NYHA class I-II symptoms Small thrombus (<0.8 cm 2 ) Emergency Surgery (I) Emergency Surgery (IIa) Fibrinolytic Rx if persistent valve thrombosis after IV heparin therapy* (IIa)
69 Thank
Echocardiographic Evaluation of Aortic Valve Prosthesis
Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Co-Director, Echocardiography, Director, Interventional Cardiology Research, Beaumont Health System
Prosthesis-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
Echocardiographic Evaluation of Mitral Valve Prostheses
Echocardiographic Evaluation of Mitral Valve Prostheses Dennis A. Tighe, M.D., FACC, FACP, FASE Cardiovascular Medicine University of Massachusetts Medical School Worcester, MA www.asecho.org 1 Nishimura
Prosthetic 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
Echocardiographic Evaluation of Aortic Valve Prosthesis
Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Co Director, Echocardiography, Director, Interventional Cardiology Research, Beaumont Health System
Echocardiographic Evaluation of Aortic Valve Prosthesis
Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Director, Interventional Cardiology Research, Beaumont Health System Associate Professor of Medicine,
A Practical Approach to Prosthetic Valves
A Practical Approach to Prosthetic Valves Bonita Anderson DMU (Cardiac), MApplSc (Med Ultrasound), ACS, AMS, FASE https://doi.org/10.1161/circulationaha.108.778886 Disclosures None 1 Know the Product Know
Stress Echocardiography: Illustrative Cases Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,
DISCLOSURE. Relevant Financial Relationship(s) Off Label Usage. None. None
Echo for TAVR Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director, Cardiology Fellowship Mayo
Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies
Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR William A. Zoghbi MD, FASE, MACC Professor and
Valvular 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
25 different brand names >44 different models Sizes mm
Types of Prosthetic Valves BIOLOGIC STENTED Porcine xenograft Pericardial xenograft STENTLESS Porcine xenograft Pericardial xenograft Homograft (allograft) Autograft PERCUTANEOUS MECHANICAL Bileaflet Single
DISCLOSURE. Echocardiography in Systemic Diseases: Questions. Relevant Financial Relationship(s) None. Off Label Usage None 5/7/2018
Echocardiography in Systemic Diseases: Questions Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate
TSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD
TSDA Boot Camp September 13-16, 2018 Introduction to Aortic Valve Surgery George L. Hicks, Jr., MD Aortic Valve Pathology and Treatment Valvular Aortic Stenosis in Adults Average Course (Post mortem data)
Managing 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
Echo Doppler Assessment of Right and Left Ventricular Hemodynamics.
Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP Northwell, Lenox Hill Hospital, New York Professor of Cardiology Hofstra University
Blank DISCLOSURES 1/17/2017 COMPLEX VALVE CASES CHALLENGES IN EVALUATING AND MANAGING MULTIVALVULAR HEART DISEASE ECHO HAWAII 1/23/17 NONE
Blank COMPLEX VALVE CASES ECHO HAWAII 1/23/17 1 David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine Director, Structural Heart Imaging The Ohio State University Division of Cardiovascular Medicine
TAVR: 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
Aortic 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
Complications of Myocardial Infarction
Complications of Myocardial Infarction Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,
Patient/prosthesis mismatch: how to evaluate and when to act?
Patient/prosthesis mismatch: how to evaluate and when to act? Svend Aakhus, MD, PhD Oslo University Hospital, Norway Disclosures: No conflict of interest Types of aortic valve prostheses (AVR) Mechanical
P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation
Comprehensive Hemodynamic Evaluation by Doppler Echocardiography Itzhak Kronzon, MD North Shore LIJ/ Lenox Hill Hospital New York, NY Disclosure: Philips Healthcare St. Jude Medical The Simplified Bernoulli
Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter.
Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP North Shore HS, LIJ/Lenox Hill Hospital, New York
Reshape/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
Usually we DON T need to go beyond the gradient
Aortic Stenosis Going Beyond the Gradient James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School of Medicine, Northwestern
Valve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal
Congenital. Unicuspid Bicuspid Quadricuspid
David Letterman s Top 10 Aortic Stenosis The victim can be anyone: Echo is the question and the answer!!!! Hilton Head Island Echocardiography Conference 2012 Timothy E. Paterick, MD, JD, MBA Christopher
MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS
MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine Director, Structural Heart Imaging The Ohio State University
PROSTHETIC. V PROSTHETIC.V
PROSTHETIC. V PROSTHETIC.V VALVE TYPE The valve types now implanted include: 1-bileaflet and tilting disc mechanical valves, 2-stented porcine and pericardial xenografts, 3-stentless porcine xenografts,
Constrictive Pericarditis
Constrictive Pericarditis Never Confused with Anything Else Jae K. Oh, MD 2018 MFMER 3712003-1 ARS #1 CP Which of following patients has constrictive pericarditis? 1 2 3 Medial e 13 cm/s Medial e 3 cm/s
ECHO 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
Choose 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
Stage of Valvular AS. Outline 10/14/16. Low-flow and Other Challenges to the Assessment of Aortic Stenosis. Severe AS
Low-flow and Other Challenges to the Assessment of Aortic Stenosis Nithima Ratanasit, MD, FACC, FASE Siriraj Hospital, Mahidol University Bangkok, Thailand Outline Types of low-flow aortic stenosis Assessment
PROSTHETIC VALVE BOARD REVIEW
PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve
Case Presentations TAVR: The Good Bad and The Ugly
Case Presentations TAVR: The Good Bad and The Ugly Vincent J. Pompili, MD, FACC, FSCAI Professor of Internal Medicine Director of Interventional Cardiovascular Medicine and Cardiac Catheterization Laboratories
M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec
M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE Honoraria: Philips Classical M-mode Echocardiography M-Mode offers better time and image resolution. Sampling Rate M-Mode: 1800 / sec
CARDIOLOGY GRAND ROUNDS
CARDIOLOGY GRAND ROUNDS Presentation: Speakers: Percutaneous Repair of Paravalvular Prosthetic Regurgitation Paul Sorajja, MD Director of the Center for Valve and Structural Heart Disease Minneapolis Heart
HOW IMPORTANT ARE THESE ECHO MEASUREMENTS ANYWAY?
HOW IMPORTANT ARE THESE ECHO MEASUREMENTS ANYWAY? John D. Carroll, MD Professor, Director of Interventional Cardiology and Co-Medical Director of the Cardiac and Vascular Center, University of Colorado
Congenital Heart Disease Cases
Congenital Heart Disease Cases Sabrina Phillips, MD FACC FASE Mayo Clinic Congenital Heart Disease Center 2013 MFMER slide-1 No Disclosures 2013 MFMER slide-2 1 CASE 1 2013 MFMER slide-3 63 year old Woman
Pericardial Disease: Case Examples. Echo Fiesta 2017
Pericardial Disease: Case Examples Echo Fiesta 2017 2014 2014 MFMER MFMER 3346252-1 slide-1 Objectives Have a systematic approach to evaluation of constriction 2014 MFMER 3346252-2 CASE 1 2013 MFMER 3248567-3
DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES
THORAXCENTRE DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES J. Roelandt DOPPLER HEMODYNAMICS Intracardiac pressures and pressure gradients Volumetric measurement
Interventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9
Interventions in Adult Congenital Heart Disease: Role of CV Imaging Sangeeta Shah MD, FACC, FASE Associate Professor ACHD mortality Pillutla. Am Heart J 2009;158:874-9 Adult Congenital Heart Disease Heterogenity
Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new
Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new B. Sonnenberg UAH Cardiology CME Day 5 May 2015 Disclosures Speaker s or Advisory Boards: none Research grants: none (co-investigator
mm Porcine valve Patient had requested
Mrs CY Age 77 History 2000:Age 60: MVR 27mm St Jude Valve (severe MR) 2015:Age 75: Paravalvular mitral leak, haemolytic anaemia, tricuspid incompetence. 27mm Porcine valve and 29mm Duran ring tricuspid
Michigan 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
What to do with a Patient with Recurrent MR after Intervention
What to do with a Patient with Recurrent MR after Intervention James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School
Quantification of Aortic Regurgitation
Quantification of Aortic Regurgitation ASE Review 2018 Boston Susan E Wiegers, MD, FASE, FACC Professor of Medicine And thanks to Dr. Roberto Lang Disclosure None related to this presentation 1 Objectives
Diastolic Function Assessment New Guideline Update Practical Approach
Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Diastolic Function Assessment New Guideline Update Practical Approach Jae K.
TAVR-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
10/1/2016. Constrictive Pericarditis Unique Hemodynamics. What s New in Pericardial Disease? Case-based Discussion
Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification What s New in Pericardial Disease? Case-based Discussion Jae K. Oh, MD Samsung
Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative
Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative Samin K. Sharma, MD, FACC, FSCAI Director Clinical & Interventional
Aortic Valvular Stenosis
Aortic Valvular Stenosis How to Assess the Four Variables for Management Low Flow / Low Gradient / Normal EF / Low EF Patrick T. O Gara, MD, MACC Brigham and Women s Hospital Harvard Medical School No
Primary 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
ASCeXAM / ReASCE. Practice Board Exam Questions. Monday Afternoon
ASCeXAM / ReASCE Practice Board Exam Questions Monday Afternoon Aortic Valve Prostheses Aortic Regurgitation Stress Echocardiography Ischemic Heart Disease and Myocardial Infarction 3D Echocardiography
Affecting the elderly Requiring new approaches. Echocardiographic Evaluation of Hemodynamic Severity. Increasing prevalence Mostly degenerative
Echocardiographic Evaluation of Hemodynamic Severity Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona Relevant Financial Relationship(s) None Off Label Usage None A re-emerging public-health
ICE: Echo Core Lab-CRF
APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction
Stress 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
Case Reviews: Hemodynamic Calculations in Valvular Regurgitation
Case Reviews: Hemodynamic Calculations in Valvular Regurgitation Case 5 History: 69-year-old man with orthotopic heart transplant 15 years ago. Inferior MI several years ago. Recurrent CHF. Currently dyspneic
TEE guided TAVR using BASILICA technique in patient with stenotic Freestyle aortic bioprosthesis
TEE guided TAVR using BASILICA technique in patient with stenotic Freestyle aortic bioprosthesis Zuyue Wang MD Associate professor, Georgetown University School of Medicine MedStar Heart and Vascular Institute
Valvular heart disease (VHD) is present in 2.5% of the
2017 Focused Update for Management of Patients With Valvular Heart Disease: Summary of New Recommendations Richard Matiasz, MD; Vera H. Rigolin, MD Valvular heart disease (VHD) is present in 2.5% of the
Options for my no option Patients Treating Heart Conditions Via a Tiny Catheter
Options for my no option Patients Treating Heart Conditions Via a Tiny Catheter Nirat Beohar, MD Associate Professor of Medicine Director Cardiac Catheterization Laboratory, Medical Director Structural
Constriction vs Restriction Case-based Discussion
Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Constriction vs Restriction Case-based Discussion Jae K. Oh, MD Samsung Professor
Echocardiographic 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
The production of murmurs is due to 3 main factors:
Heart murmurs The production of murmurs is due to 3 main factors: high blood flow rate through normal or abnormal orifices forward flow through a narrowed or irregular orifice into a dilated vessel or
Low 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
Adult Cardiac Surgery
Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease
Relevant Financial Relationship(s) Off Label Usage. None. None
Different Variants Amr E Abbas, MD, FACC, FSCAI, FASE, FSVM Director, Interventional Cardiology Research Beaumont Health Associate Professor of Medicine, OU/WB School of Medicine ASCeXAM/ReASCeXAM 2018
Aortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology
Aortic Stenosis: UPDATE 2010 Anjan Sinha, MD Krannert Institute of Cardiology None Disclosures 67-Year-Old Male Dyspnea and angina Class III heart failure No PND or orthopnea 3/6 late peak SEM Diminished
Echo Emergencies. Outline. Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures
Echo Emergencies Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures Outline Common emergency / on call scenarios Tamponade Pulmonary embolism/rv strain Cardiogenic
Focused. se with 2008 F. lar Heart Diseas. date. ents With Valvul. Upd. gement of Patie. lines for Manag. HA 2006 Guidel ACC/AH. Fig.
ACC/AH HA 2006 Guidel nic severe AI (Fig. 4). ned by age, ay also be helpful nd echo. For AI, ollow up may be or MRI rather than mension; SD, end lines for Manag gement of Patie Upd ents With Valvul date
Mitral Valve Stenosis: What do I need to know? ACC Latin American Conference 2017
Mitral Valve Stenosis: What do I need to know? ACC Latin American Conference 2017 Athena Poppas, MD FACC FASE Past ACC Scientific Sessions Chair, ACC Board of Trustee Professor of Medicine, Brown University
Federico M Asch MD, FASE MedStar Heart and Vascular Institute Georgetown University Washington, DC
TAVR: When Things go Wrong Federico M Asch MD, FASE MedStar Heart and Vascular Institute Georgetown University Washington, DC Disclosures Academic Echo Core Lab Abbott / St Jude Medical Edwards Medtronic
Diastolic 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
Low 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
Potential conflicts of interest
Potential conflicts of interest Speaker's name: Petros Dardas MEDTRONIC proctor for TAVI Intermediate risk 83 FEMALE COAD SEVERE AS NYHA III Mean gradient 35 mmhg, AVA 0.45cm2, SVI 21ml/m2 Paradoxical
Transcatheter heart valve thrombosis
Transcatheter heart valve thrombosis Jeroen J Bax Dept Cardiology Leiden, The Netherlands New York, 2017 The department of Cardiology of the Leiden University Medical center received research grants from
Bogdan A. Popescu. University of Medicine and Pharmacy Bucharest, Romania. EAE Course, Bucharest, April 2010
Bogdan A. Popescu University of Medicine and Pharmacy Bucharest, Romania EAE Course, Bucharest, April 2010 This is how it started Mitral stenosis at a glance 2D echo narrow diastolic opening of MV leaflets
Successful Percutaneous Closure of Mitral Bioprosthetic Paravalvular Leak Using Figulla ASD Occluder
Hans R. Figulla, M.D., PhD ; Ali Hamadanchi, M.D. Medicine, Pneumology Universitity Hospital, Jena, Germany Successful Percutaneous Closure of Mitral Bioprosthetic Paravalvular Leak Using Figulla ASD Occluder
«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
ASE 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
Procedural Guidance of TAVR: How to Assure it Goes Right and What to Do If It Doesn t
Procedural Guidance of TAVR: How to Assure it Goes Right and What to Do If It Doesn t James D. Thomas, M.D., F.A.C.C. Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic
Echo Assessment Pre-TAVI
Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial Interest /arrangement or affiliation with the organization(s) listed below Echocardiographic
Aortic Regurgitation & Aorta Evaluation
VALVULAR HEART DISEASE Regurgitation Valvular Lessions 2017 Aortic Regurgitation & Aorta Evaluation Jorge Eduardo Cossío-Aranda MD, FACC Chairman of Outpatient Care Department Instituto Nacional de Cardiología
Quantification of Mitral Stenosis: Planimetry, pressure Half time, Continuity Common Errors
Quantification of Mitral Stenosis: Planimetry, pressure Half time, Continuity Common Errors Christopher J Kramer RDCS Advanced Cardiovascular Services Aurora Health Care Milwaukee, WI No Disclosures Baumgartner,
2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease
2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease Patrick T. O Gara, MD BWH Heart and Vascular Center Professor of Medicine, Harvard Medical School Disclosures NHLBI CTSN Co-chair
SONOGRAPHER & 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
ECHOCARDIOGRAPHY DATA REPORT FORM
Patient ID Patient Study ID AVM - - Date of form completion / / 20 Initials of person completing the form mm dd yyyy Study period Preoperative Postoperative Operative 6-month f/u 1-year f/u 2-year f/u
Doppler echocardiography is currently the
Doppler Echocardiography of 119 Normal-functioning St Jude Medical Mitral Valve Prostheses: A Comprehensive Assessment Including Time-velocity Integral Ratio and Prosthesis Performance Index* Joseph F.
Heart Valves: Before and after surgery
Heart Valves: Before and after surgery Tim Sutton, Consultant Cardiologist Middlemore Hospital, Auckland Auckland Heart Group Indications for intervention in Valvular disease To prevent sudden death and
Dysfunction of transcatheter mitral valve prosthesis. Early valve degeneration or thrombosis - that is the question.
Dysfunction of transcatheter mitral valve prosthesis. Early valve degeneration or thrombosis - that is the question. Böhm A., Hricak V., Tomasovic B., Bena M., Postulka J. The National Institute of, Department
Echocardiographic Cardiovascular Risk Stratification: Beyond Ejection Fraction
Echocardiographic Cardiovascular Risk Stratification: Beyond Ejection Fraction October 4, 2014 James S. Lee, M.D., F.A.C.C. Associates in Cardiology, P.A. Silver Spring, M.D. Disclosures Financial none
Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle
Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle No conflicts of interest Acute Aortic Regurgitation Causes aortic
Diastolic Function Assessment Practical Ways to Incorporate into Every Echo
Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Jae K. Oh, MD Echo Hawaii 2018 2018 MFMER 3712003-1 Learning Objectives My presentation will help you to Appreciate the importance
Tricuspid 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 Question 1 All of the following
Endocarditis and Its Complications: The Role of Echocardiography
Endocarditis and Its Complications: The Role of Echocardiography Pravin Patil, MD FACC FASE Associate Professor of Medicine Director, Cardiovascular Disease Training Program Lewis Katz School of Medicine
Subclinical Thrombosis of Bioprosthetic Aortic Valves: Is It Clinically Relevant? Tarun Chakravarty, MD
Subclinical Thrombosis of Bioprosthetic Aortic Valves: Is It Clinically Relevant? Tarun Chakravarty, MD Interventional Cardiology Cedars-Sinai Heart Institute Disclosures Consultant and proctor for Edwards
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?
Hemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics
Hemodynamic Assessment Matt M. Umland, RDCS, FASE Aurora Medical Group Milwaukee, WI Assessment of Systolic Function Doppler Hemodynamics Stroke Volume Cardiac Output Cardiac Index Tei Index/Index of myocardial
TAVR: 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