Exam 3 Flashcards
Transcatheter Mitral clip
-replacing the Alferi stitch
-clip placed on leaflets tips to hold together
-blood flows on sides of clip
-brought through the LA to LV
Annuloplasty
-D shaped ring placed in left atrium and brings the MV closer together
Surgical Mitral Valve Prolapse Repair
-minimally invasive
-triangular resection of sagging scallop
-annular ring is sewn in to tighten annulus
-anterior repair may involve chordal transfer/creation of new chords
-repairs followed by annular ring
Homograft Valve
-cryopreserved human aortic or pulmonic valves harvested at autopsy (human to human donation)
-valve conduit: valve with portion of great vessel
-typically preserved as a block
Autograft Valves
self to self donation
Artificial Valve Conduits
fabric like tube with implanted mechanical valve
Bioprosthetic Tissue Valve
heterografts
animal to human donation
3 types: stented (porcine), stentless, catheter
Mechanical Valves
made of carbon to titanium
-2 types: Tiilting Disk or Bileaflet
Composition of Bioprosthetic Stented
-leaflets or pericardium shaped to mimic leaflets, mounted on cloth covered rigid support ring with a raised stent at each of the 3 commissures
Composition of Bioprosthetic Stentless
-flexible cuff of fabric or tissue support the valve leaflets
-coronary arteries may need to be reattached
Composition of Catheter
-transcatheter aortic valve replacement “TAVR”
-tissue leaflets mounted on compressible stent
Specially designed bioprosthetic vavles implanted by transcatheter approach with tissue leaflets mounted on compressible stent
Mechanical Bileaflet
-two semicircular disks hinged on sewing ring
-two thin lines of reverberation
-2 large lateral inflow
-1 small central inflow
Mechanical Tilting disk
-singular circular disk supported on central strut running across the sewing ring
-major and minor inflow
-one thick line of reverberation
Ross Procedure
-self to self donation
-AV is replaced with child’s own PV = pulmonary autograft
-homograft put in PV position
Advantage and disadvantage of Bioprosthetic
Advantage: does not require anticoagulation therapy
Disadvantage: average longevity is 10 years due to degenerative calcific process
Advantage and disadvantage of Mechanical
Advantage: longevity due to durability
Disadvantage: lifelong anticoagulation therapy
Bioprosthetic Valve Stenosis
-fibrocalcific changes of leaflets
-results in resistance to opening
Bioprosthetic Valve Regurgitation
-fibrocalcific changes of leaflets
-results in failure to coapt
-acute regurgitation: if calcium tears leaflets
-paravalvular regurgitation: loss of suture material postoperatively
Mechanical Valve Stenosis
-due to thrombus formation or pannus ingrowth around valve
-failure due to faulty design or wear & tear resulting in incomplete valve closure or disk escape
Mechanical Valve Regurgitation
-due to thrombus formation or pannus ingrowth around valve
-failure due to faulty design or wear & tear resulting in incomplete valve closure or disk escape
-paravalvular regurgitation: loss of suture material postoperatively
Paravalvular Regurgitation
-loss of suture material postoperatively
-regurgitation between tissue and sewing ring
Dehiscense
-major loss of sutures thus sewing ring is no longer adequately seated and the prosthesis rises off the annulus
-“rocking” motion of prosthetic
Endocarditis on bioprosthetic
-presents as vegetations
Endocarditis on mechanical
-presents as paravalvular abscess
-pocket of infection separating the valve from the sewing ring
2D appearance on Bioprosthetic Stented
-hard to visualize 3 leaflets
-metal struts appear as crown
2D appearance on Bioprosthetic Stentless
-similar to native AV
-increased echogenicity
2D appearance on Transcatheter
-increased echogenicity of para-annular region
2D appearance on Mechanical
-severe reverberations and acoustic shadowing
-spontaneous contrast due to microcavitation
Doppler tracing through Prosthetic and Mechanical
-greater intensity opening and closing clicks
-can cause color flash artifact
-due to occluder, disk, or tissue leaflets hitting sewing ring
-triangular shaped envelopes in mechanical valves
Color flow regurgitation pattern on prosthetic
Bioprosthetic: central regurgitation
TAVR: mild paravalvular
Color flow regurgitation pattern on mechanical
Mechanical: crisscross jets, small regurgitant jet circumferentially, closure line regurgitation on tilting disk
Baseline Echo
-secure within 3 months of valve replacement
-evaluation of regression of LV hypertrophy or dilation
-evaluation of recovery of systolic function
-evaluation of changes in pulmonary pressures
AV Quantification
Velocity: < 3
MPG: < 20
DVI: ≥ .30
EOA: > 1.2
Accel Time: < 80 (triangular shaped)
Severe AV Quantification
Velocity: > 4
MPG: > 35
DVI: < .25
EOA: < .8
Accel Time: > 100 (rounded shape)
MV Quantification
Velocity: < 1.9
MPG: < 5
VTI: < 2.2
EOA: > 2
PHT: < 130
Severe MV Quantification
Velocity: > 2.5
MPG: > 10
VTI: > 2.5
EOA: < 1
PHT: > 200
Comparision Resources
Compare values to:
-Baseline Echo (most valuable)
-ASE Guidelines
-Manufacturer
Mismatch Prosthetic
-done during baseline echo
AV indexed EOA: ≤ .85 cm^2/m^2
Severe AV: ≤ .65 cm^2/m^2
MV indexed EOA: ≤ 1.3 cm^2/m^2
