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To pass CT certification

1
Q

Degree of MR needed for the Apollo trial?

A

Primary Cohort: Moderate-Severe to Severe MR MAC Cohort: Moderate MR, MAC >750 mm² and Mitral Stenosis CT DOS criteria: < 180 days

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2
Q

What is the cine function in 3Mensio? Why is it useful?

A

To play multiphase Cine loop. Plays all phases.
So, you can see the valves open/close, and the ventricle dilate/contract.

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3
Q

What is the saved work called in 3mensio?

A

A session

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4
Q

Gating requirements

A

10% increments starting at 0% of R-R interval and ending at 90%. (smallest slices possible, less than 1mm)
10 total phases

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5
Q

Desired Increments and phases

A

10% (0-90) -10 phases

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6
Q

5 structural components of the MV apparatus

A

Mitral Annulus -Mitral Leaflets (Anterior and Posterior) Papillary Muscles -Commissures (Posteromedial and Anterolateral)
Chordae Tendineae

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7
Q

Define the mitral annulus

A

The mitral annulus constitutes the anatomical junction between the ventricle and the left atrium and serves an insertion site for the leaflet tissue.
Left and right trigones and mitral aortic continuity

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8
Q

Which disease states affect how we measure our annulus?

A

MAC and Annular rings

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9
Q

What are the mitral leaflets doing in systole?

A

Systole: Closing -Diastole: Opening

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10
Q

Factors that most typically contribute to degenerative (primary) MR?

A

Abnormality of mitral valve leaflets

Prolapse-Leaflets bulge upward into atrium

Leaflet flail

Damaged Chordae

Barlow’s Disease

Annular dilation, thick/spongey leaflets

Rheumatic fever

Endocarditis- Infection of heart lining

Calcification/thickening

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11
Q

What causes functional (secondary) MR? How does this affect the dimensional variability of the mitral annulus?

A

Abnormality/disease of the LV or LA
Dilated LV -Weak Pap muscles -Ischemic etiology: LV dysfunction/remodeling
Annular dilation -AFib (irregular/rapid heart rate)
Restrictive cardiomyopathy: chambers of heart become stiff, hard for heart to fill.
Annulus could be dilated

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12
Q

Aortomitral curtain location and structural components

A

Fibrous thickening separating the aortic valve leaflets from the mitral valve proper.
Fibrous skeleton of heart
Located between medial and lateral trigones, connecting it to the left and non-coronary cusps of the aortic valve

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13
Q

Differences between the posterior and anterior leaflet morphology

A

Anterior: Makes up 1/3 of the Mitral annulus but covers 2/3 of the valve area. -Larger, thicker, dome-shaped. (A1, A2, A3) Posterior: Makes up 2/3 of the Mitral annulus but covers 1/3 of the valve area. -Thin, crescent shaped. (P1, P2, P3)

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14
Q

Know the two device sizes

A

42mm & 48mm

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15
Q

Diameter OS min (AP/CC)

A

≥ 10%

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16
Q

Outer diameter of the inner stent

A

28mm Outer diameter of inner stent (27mm inner diameter)

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17
Q

Complications if annulus diameter is less than the inner stent diameter

A

Frame to frame interaction. Perivalvular leaks. Valve migration.

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18
Q

Explain what the Neo-LVOT is

A

LVOT space after virtual valve is placed/Residual LVOT area after TMVR implantation

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19
Q

Initial phase used for LVOT assessment

A

End Systole

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20
Q

Anatomical structures used to determine end-systole

A

MV leaflets
Aortic valve leaflets and ventricle
End Systole = Smallest LV cavity, MV closed, AoV usually closed… End-systole is the phase where the Aortic valve first closes, and the Mitral valve is still closed, and LV is contracting

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21
Q

Values used for the virtual device dimensions (cone) (height, inflow, outflow, skirt height)

A

Height: 10 - Inflow: 48/42 -Outflow: 28 -Skirt Height: 0

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22
Q

Proper placement of virtual valve from MV plane

A

35Fr: 8/9mm or -13/-14
29Fr: 7/7mm or -11.5/-12

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23
Q

Name of the method used for Neo-LVOT Assessment

A

Cone Method

24
Q

Understanding the affect that different regions of the annulus have on the Neo-LVOT

A

Basal Septum may interact with Intrepid
Posterior MAC/Posterior ridge may push intrepid anterior Anterior Valve leaflet length

25
Fossa Ovalis Use for procedure
Posterior and Mid Inferior: So, we can understand how much height we will have above the annulus and how much space we have in the LA
26
Explain SFVR and what it means
Sheath to Femoral Vein ratio: How big the sheath is in relation to the Femoral vein
27
What are the most common reasons for a screen failure?
-Neo-LVOT is too small, Annulus is too big -EF requirements for Apollo >25% (Used to be 30%)
28
Degree of MR needed for the Apollo trial?
Primary Cohort: Moderate-Severe to Severe MR MAC Cohort: Moderate MR, MAC >750 mm² and Mitral Stenosis CT DOS criteria: < 180 days
29
Intrepid Yesterday:
1st Gen Intrepid: Original TWELVE Device - Non-recoverable TA System 2nd Gen Intrepid: 35Fr Recoverable TA System - 1B Device
30
Intrepid Today :
2nd Gen TF System: - 29Fr Transfemoral Device - Non-recoverable 35Fr Transfemoral Recoverable System - 35Fr 1B Device
31
Degenerative (Primary) Mitral Regurgitation (DMR)
Pathology due to abnormality of mitral valve leaflets: Prolapse: Leaflet(s) bulge upward into the left atrium Flail Leaflet: Caused by damaged chordae tendineae - Barlow’s Disease: Annular dilatation, MVP, thick/spongy leaflets due to excessive myxomatous tissue - Calcification/Thickening Rheumatic Fever Endocarditis Congenital: Cleft anterior mitral valve leaflet/Parachute MV (single papillary muscle)
32
Functional (Secondary) Mitral Regurgitation (FMR)
Pathology due to disease of the left ventricle or left atrium: Ischemic etiology: LV dysfunction/remodeling = heart shape change Annular dilatation: Atrial fibrillation, restrictive cardiomyopathy Dilated LV: Decreased coaptation Weakened papillary muscles
33
Perimeter Range (mm):
42: 99–117mm 48: 114–134mm
34
Diameter (mm):
42: 28–39mm 48: 29–45mm
35
Annulus Area (cm²):
42: 7.3–10.4 48: 9.6–13.8
36
35Fr Device: Device Frame Specifications
Fixation Ring (mm): 42 mm = 12 mm, 48 mm = 13 mm Frame Height (mm): 42 mm = 24 mm, 48 mm = 27 mm Inner Frame ID (mm): 27 mm (for both sizes)
37
29Fr Device: Device Frame Specifications
Outer Frame Height (mm): 42 mm = 10 mm, 48 mm = 10 mm Frame Height (mm): 42 mm = 20 mm, 48 mm = 22 mm Inner Frame ID (mm): 27 mm (for both sizes) Inner Frame Height (mm): 42 mm = 31 mm, 48 mm = 31 mm
38
Virtual 35Fr Intrepid (42 vs. 48 mm)
42 mm/48 mm Device Height (mm): 10 mm (for both) Outflow (mm): 28 mm (for both)
39
Inflow Position from MV Plane (mm):
35 FR 42: 8 mm 48: 9 mm 29FR 42: 7mm 48: 7mm
40
Transfemoral Workflow – Venous Anatomy
The vessel is segmented from the IVC/RA ostia down to the bottom of the Right Femoral head Measurements are taken every 10 mm starting from the mid-femoral head up to the IVC bifurcation
41
Vessels measured for SFVR analysis:
Right Femoral vein Right External Iliac vein Right Common Iliac vein to IVC confluence
42
Post Crimp Data for 42mm & 48mm
Post Crimp Diameter (mm): 41 mm Post Crimp Perimeter (mm): 128.8 mm 47mm 147.7mm
43
Fossa Ovalis (FO) Anatomy Role in Procedures
The Fossa Ovalis (FO) is a depression in the right atrium at the level of the interatrial septum (IAS) - The FO is a remnant of a thin fibrous sheet that covered the foramen ovalis during fetal development - FO is the thinnest part of the IAS and the crossing point for transseptal (TS) procedures
44
2014
FIH Implant in Krakow, Poland
45
2015
Medtronic acquires Twelve
46
2017
October - First patient implant in Apollo
47
2020
February - FIH implant of TFTS in EFS trial
48
2021
January - First TVR Implant EFS
49
2024
January - 29Fr Transfemoral System
50
2022
February - TFTS rolls into Apollo
51
2023
February - Final TA Implant
52
Fossa Ovalis Puncture Location for Intrepid
For Intrepid TMVR TS implants, the goal is to aim posteriorly and inferiorly through the FO to be coaxial with the mitral valve annulus
53
Post Crimp Data for 48mm
Post Crimp Diameter (mm): 47 mm Post Crimp Perimeter (mm): 147.7 mm
54
Intrepid Tomorrow
29Fr Device - XL Valve (54mm / 154mm) - 1C for TVR - Anatomic Expansion & Improved Performance
55
Perimeter OS range
10-30%
56
AP & CC OS Requirements?
(less than or equal to) <10%

CT Review (1 decks)

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