Interventional/Advance/Transplant Flashcards
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.
lengthening and thickening of myocardial fibers
Positive strain
shortening and thinning of myocardial fibers
Negative strain
Myocardial Strain Imaging
Clinical application
- Used as a marker of myocardial function*
- Detect changes in regional function*
Left Heart Cath
performed with ______
pigtail catheter
LV cath procedures (3)
coronary angiogram - assesses the coronary artery for CAD (gold standard)
Angioplasty (aka: percutaneous transluminal coronary angioplasty/PTCA)
IVUS - intavascular ultrasonography
IVUS stand for
intravascular ultrasonography/ultrasound
Right Heart Cath
performed with
Swan-Ganz catheter
right heart cath procedures
transseptal procedure
fluoroscopy
acquire LAP via pulmonary capillary wedge pressure
IVUS contraindications:
severe HTN
ventricular arrhythmia
acute MI
allergy to radioactive contrast
GI bleeding
__________ 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)
_________________________ 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
This technique uses a small catheter with a miniature ultrasound transducer to visualize the internal vascular anatomy
IVUS
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
***IVUS mechanical TDR catheter tip rotates at ______ per min and measure entire vessel diameter
1800
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)
- Screen for AR or LV apical thrombus prior to implantation
- 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 _________
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 in 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
