Interventional/Advance/Transplant Flashcards by Yoshiko Peterson

Myocardial Strain Imaging

What is strain?

Strain is a measure of how much an object has been deformed represented by a percent or fractional change in dimension.

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lengthening and thickening of myocardial fibers

Positive strain

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shortening and thinning of myocardial fibers

Negative strain

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Myocardial Strain Imaging

Clinical application

- Used as a marker of myocardial function*
- Detect changes in regional function*

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Left Heart Cath

performed with ______

pigtail catheter

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LV cath procedures (3)

coronary angiogram - assesses the coronary artery for CAD (gold standard)

Angioplasty (aka: percutaneous transluminal coronary angioplasty/PTCA)

IVUS - intavascular ultrasonography

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IVUS stand for

intravascular ultrasonography/ultrasound

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Right Heart Cath

performed with

Swan-Ganz catheter

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right heart cath procedures

transseptal procedure

fluoroscopy

acquire LAP via pulmonary capillary wedge pressure

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IVUS contraindications:

severe HTN

ventricular arrhythmia

acute MI

allergy to radioactive contrast

GI bleeding

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__________ provides a bloodless field for cardiac surgery. It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump.

Cardiopulmonary bypass (CPB)

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_________________________ is a mature imaging modality and critical component of contemporary heart surgery, in which it plays a key role in surgical planning, determination of cardiac chamber filling and function early after cardiopulmonary bypass, and timely assessment of surgical interventions.

Intraoperative TEE

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This technique uses a small catheter with a miniature ultrasound transducer to visualize the internal vascular anatomy

IVUS

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2 types of IVUS

mechanical and phased array

pros and cons?

Mechanical (Uses a single mechanical transducer that is mounted at the catheter tip and rotates at 1800 rotations per minute (rpm)
- Image display: cross-sectional view of artery
- Pros: High image quality
- Cons: decreased catheter flexibility
Phased array
- Use multiple TDR elements
- Pros: more flexible
- Cons: lower temporal resolution

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***IVUS mechanical TDR catheter tip rotates at ______ per min and measure entire vessel diameter

1800

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What is ICE?

intracardiac echocardiography i.e. AcuNav

*Note:

要は… guiding/monitoring for:

IAS closure, LAA closure, PV ablation, transluminal septal myocardial ablation

Peri-interventional imaging of:

Asc Ao, AoV, Dsc thoracic Ao, MV

Point:

High frequency rotating catheter probes in the range of 20-30 MHz

Intracoronary investigations: atherosclerosis, vascular response to stents and coronary remodeling

Guidance for placement of closure devices for ASDs, electrophysiological ablation procedures, alternative guiding tool for intervention procedures especially in pediatric patients.

Does not require general anesthesia

***Cardiac Transplant: Echo Features of Rejection (4)

increase in LV wall thickness >4mm
>10% decrease in LV/RV systolic function
increase in RVSP
new or sudden change in PE
restrictive filling: > 20% decrease in pressure half time from immediate post operative echo, E/e’ > 8, 20 % decrease in IVRT

Cardiac Transplantation Complications: (4)

CAD (graft atherosclerosis)

infection

rejection

silent MI due to denervation (chest pain receptors are cut, resulting in inability to feel angina and altered conduction pathways)

)

cardiac transplantation

primary indication (3)

dilated CM

cardiac amyloid disease

CHD

Surgical Techniques used in Cardiac Transplantation

the recipient’s heart is removed and the donor’s heart is placed in the correct anatomical position

Orthotopic (biatrial or bicaval)

Surgical Techniques used in Cardiac Transplantation

the donor heart is placed in the right chest alongside the recipient organ and anastomosed in a way to allow blood to pass through either or both hearts.

heterotopic

Surgical Techniques used in Cardiac Transplantation

transplantation of the heart from a different species

xenotransplantation

Surgical Techniques used in Cardiac Transplantation

surgically implanted mechanical heart designed to replace the diseased heart

artificial heart

a type of therapy used for patients in end stage LV dysfunction

CRT

what does CRT stands for?

**cardiac resynchronization therapy**

\_\_\_\_\_\_\_\_\_\_ is the result of **premature regional contraction** before ejection or delayed regional contraction. It disrupts the normal coordinated sequence of contraction and results in a **decrease in EF**

**Dyssynchrony**

**3 types of dyssynchrony:**

**Interventricular dyssynchrony** * Result from **LBBB** due to **abnormal septal motion** * Measured by Doppler (difference between the left and the right ventricular pre-ejection intervals from onset of QRS to onset of aortic and pulmonary outflow * **Difference in ejection delays \> 40 ms** is a **sign of interventricular dyssynchro** **Intraventricular dyssynchrony** * May cause **reduced SV** & abnormal myocardial stress * Assess by **M-mode** from **PSAX** * **Septal to posterior wall motion delay** is **marker** ***Atrioventricular (AV) dyssynchrony*** May also lead to **heart failure**; however, there is **limited information** on the effects of AV resynchronization.

**what is LVAD ?**

**(left Ventricular Assist Device)** 1. Screen for **AR** or **LV apical thrombus** prior to implantation 2. Use **Doppler** to evaluate pump setting

**LV pseudoaneurysm** is a rare but serious complication of **MI, cardiac surgery, trauma and infection.** **\_\_\_\_% mortality rate (**medical treatment frequently ineffective) **Surgery = high mortality therefore** **\_\_\_\_\_\_\_\_\_ is highly effective**

**50** **transcatheter closure**

**Mitraclip** System is based on the principle of \_\_\_\_\_\_\_\_\_ ## Footnote technique is a method to treat mitral valve regurgitation by suturing the edges of the leaflets at the site of regurgitation. Although the method is technically simple, its application should follow a few rules to ensure effective and durable results, and to avoid complications.

**edge-to-edge repair**

TAVR stands for

transcatheter aortic valve replacement

Type of TAVR: **balloon** expandable

**Edward SAPIEN & SAIEN -XT**

Type of TAVR: **self** expanding

Medtronic Core Value

\_\_\_\_\_\_\_ is so important because **it represents the average of the longitudinal strain of all myocardial segments** obtained in A4C, A2C & A3C.

**GLS**

Of all the parameters, \_\_\_\_\_\_\_\_\_\_ is the most used one because it represents the shortening of the **subendocardial fibers** which are the **first fibers to be affected i**n most cardiopathies.

**Longitudinal strain**

***lengthening and thickening of myocardial fibers = \_\_\_\_\_\_strain***

***Positive***

***shortening and thinning of myocardial fibers = _______ strain***

***Negative***

\_\_\_\_\_\_\_\_\_\_ is a procedure done to remove fluid that has built up in the pericardium. It's done using a needle and small catheter to drain excess fluid.

**Pericardiocentesis**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_is performed by placing the ultrasound transducer on the epicardial surface of the heart to acquire 2-dimensional and color flow, and spectral Doppler images in multiple planes.

**Epicardial echocardiography**