Interventional / Intraop Flashcards
TAVR low implantation complications
Paravalvular regurgitation
MV disruption
CHB
Underexpanded TAVR complications
Paravalvular regurg
Prosthetic regurg
Decreased durability
Seimquantitative Parameters for TAVR paravalvular regurgitation
Jet width at its origin (% LVOT diameter)
PHT
Descending aortic diastolic flow reversal
Circumferential extent of paravalvular regurgitation
TAVR paravalvular Jet width at origin
Mild 5-15%
Moderate 30-45%
Severe >60%
TAVR paravalvular PHT
Mild > 500
Mod 200-500
Severe < 200
TAVR paravalvular descending aorta diastolic flow reversal
Mild - absent or brief
Moderate - intermediate
Severe - holodiastolic
TAVR
Circumferential extent of paravalvular regurgitation
Mild <10%
Mod 10-29%
Severe >= 30%
TAVR paravalvular
RVol
Mild < 15
Mod 30-45
Severe > 60
TAVR paravalvular RF
Mild < 15%
Mod 30-40%
Severe > 50%
TAVR paravalvular ERO
Mild < 0.05
Mod 0.10-0.20
Severe > 0.30
Ideal TMVR segment
P2
Ideal TMVR calcification
None
Ideal TMVR MVA
> 4 cm2
may attempt 3.5-4cm2
Ideal TMVR MV gradient
<4 mm Hg
Ideal TMVR flail width
<15 mm
Ideal TMVR flail gap
<10 mm
Flail width
Width along scallop
Flail gap
Distance between anterior and posterior leaflets
Suboptimal TMVR anatomy
Prior endocarditis
Rupture / perforation
Bulky MAC
Small baseline MVA
TMVR complications
Device embolization rare Partial clip detachment 2% MS 0.5% Tamponade 2% Injury to atrial septum repair
Percutaneous paravalvular regurgitation repair complications
Prosthetic leaflet impingement (tilting disc) Device embolization Coronary obstruction (aortic) Stroke / TIA Pericardial effusion
TEE sizing for LAAO
Measure at every 45 degrees
Measure osmium and depth in each view
Use largest diameter, usually at 135 degrees
LAAO complications
Effusion / tamponade 1.3%
Device embolization 1.3%
Stroke 0.7%
MV repair leading to LV and RV dysfunction
Pre-op LV dysfunction unmasked
Air down coronaries
Lcx artery issues
New MI
TV repair rec when undergoing MV surgery
Annulus >= 3.5-4.0 cm
MV scallops 4 chamber view
anterior and posterior leaflet
MV scallops commissural view 60’
3 medial - 2 middle - 1 lateral
3D echo surgeon’s view MV scallops
A1 / P1 lateral
A2 / P2 middle
A3 / P3 medial
MR jet not going in expect direction based on anatomy
Cleft like indentation
Intraop air embolization coronary territory
RCA
TEE for LVAD placement indication
Exclusion of AR
Most specific criteria for severe MR
ROA >= 0.4 mm2
VC >= 7 mm
Underfilled LV and LV volumes / EF
Decreased EDV, ESV
Increased EF
Most common transient abnormality after placement of stented bioprosthesis
Small periprosthetic regurgitation
Complication of MV repair when LV small and hyperdynamic
SAM
EF on CPB
May be higher or lower
Preferred TEE view for LV apex
Transgastric long axis of LV
TEE aorta blind spot
Mid ascending aorta
Caused by trachea between aorta and esophagus
MR caused by AR
Perforation of leaflet by AR jet
Intervalvular fibrosa
Posterior part of AV annulus
Anterior part of MV annulus
Septal side of TV annulus
Solid structure to which AV attached anteriorly, MV attached posteriorly
Risk for coronary obstruction with TAVR
Height of left main <10 mm above annulus
Female sex
Ideal TMVR coaptation length
> = 2 mm
Ideal TMVR coaptation depth
<= 11mm
Complications of LARIAT device
Access complications
Pericarditis, pericardial effusion
Unexplained sudden death
Late stroke
Successful alcohol septal ablation
reduction of LVOT gradient >=50%
Can’t use LARIAT with this type of LAA
Chicken wing
