Insuffisance mitrale

Transcription

1 Imagerie Multimodalité dans les Valvulopathies: De quoi avons nous besoin? Insuffisance mitrale Agnès Pasquet, MD, PhD Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université catholique de Louvain

2 Déclaration de Relations Professionnelles Disclosure Statement of Financial Interest Je n ai actuellement, ou n'ai eu au cours des deux dernières années, une affiliation ou des intérêts financiers ou intérêts de tout ordre avec une société commerciale ou je reçois une rémunération ou des redevances ou des octrois de recherche d'une société commerciale : I currently don t have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : No relationship to disclose 2

3 Mitral valve regurgitation: Correct assessment of mitral anatomy and function is of outstanding importance specially if you decide to sent the patient for a repair surgery or a percutaneous procedure. Several tools could be used: 2D TT and TEE echocardiography 3D echocardiography CMR MSCT 3

4 Mitral valve regurgitation: Several point need to be addressed What is the anatomy of the mitral valve What is the severity of mitral regurgitation What're the functional repercussion of mitral regurgitation 4

5 Mitral valve regurgitation: echocardiography for anatomic assessment Echocardiography is the corner stone for anatomic assessment Stenotic MV Restrictive MV MV prolapse Ruptured pap muscle 5

6 Mitral valve regurgitation: TOE assessment A2 P2 A2 P3 A3 P3 A2 P1 P2 A1 A Barlow MV prolapse Stenotic MV Endocarditis 6

7 Mitral valve regurgitation: TOE vs TTE Sensitivity (%) Specificity (%) Accuracy (%) Vegetations TTE (n = 279) TEE (n = 267) Ruptured chordae TTE (n = 275) TEE (n = 266) 97* 91* 95* Calcified annulus TTE (n = 270) TEE (n = 265) Monin et al, JACC 2005; 46:

8 Mitral valve regurgitation: TOE assessment 8

9 Mitral valve regurgitation: TOE assessment 9

10 Mitral valve regurgitation: TOE assessment Ant 10

11 Mitral valve regurgitation: TOE assessment Prolapsus commissural antérieur Ant 11

12 Mitral valve regurgitation: 2D vs 3D Grewal et al., J Am Soc Echo 2009;22-34

13 Mitral valve regurgitation: Mitral valve anatomy analysis 13

14 Mitral valve regurgitation: Mitral valve anatomy by CMR Short Axis Ao AC A1/P1 A2/P2 A3/P3 PC A3/P3 A2/P2 A1/P1 14

15 Mitral valve regurgitation: Mitral valve anatomy by MDCT Delgado et al, JACC imaging 2009;2:

16 Mitral valve regurgitation: Quantification of Mitral regurgitation Color jet area Pulsed Doppler continuity equation Vena contracta PISA 16

17 Mitral valve regurgitation: MR quantification Vena contracta Khalert et al., JASE. 2008;21:

18 Mitral valve regurgitation: MR quantification PISA Khalert et al., JASE. 2008;21: Marsan et al JACC imaging 2009; 2:

19 Mitral valve regurgitation: Exercise Echocardiography Lancelotti et al., Circulation 2003:108; Lancelotti et al, J Am Coll Cardiol 2003,42:

20 Mitral valve regurgitation: MR quantifcation CMR regurgitant orifice area Buchner et al Circ CV imaging 2008; 1:

21 Mitral valve regurgitation: MR quantifcation CMR velocity encoding Thavendiranathan et al., JACC 2012:60:

22 Mitral valve regurgitation: Assessment of LV function 3D echo 22

23 Mitral valve regurgitation: Assessment of LV function CMR Pouleur et al, Heart 2008:94:

24 Mitral valve regurgitation: MSCT to exclude Coronary Artery Disease Bettencourt N et al, Circ imag 2009:2:

25 Mitral valve regurgitation: CMR for myocardial viability 25

26 Mitral valve regurgitation: CMR papillary muscle necrosis Han et al, JACC imaging 2008;1:

27 Mitral valve regurgitation: percutaneous Alfieri 27

28 Mitral valve regurgitation: Summary ESC guidelines 2012 valvular heart disease, 28

29 Mitral valve regurgitation: Conclusion Echocardiography remains the technique of choice to obtain precise assessment of mitral valve anatomy and function. Nevertheless, MRI could be useful to answer clinical question when there is some discrepancies between first results and clinic or when echo is unable to answer the question. MDCT is mainly proposed to rule out coronary artery disease in patient with valvular heart disease 29

30 Mitral valve regurgitation: Ceci n est pas une valve mitrale Thank you for your attention 30

31 Mitral valve regurgitation: A 31