TAVR, Mitraclip, Epicardial Flashcards
Risk factors for neurologic injury
age, female sex, prior stroke, systolic htn, diabetes, asc ao atherosclerosis
risk factors for atherosclerosis of asc ao
old age
htn
unstable angina
copd
stroke
pvd
elevated creatinine
What is the standoff in epiaortic images
the space between aorta and probe
bubbles in standoff can present as artifact in aorta!
linear vs phased array
linear does have standoff, but may not see all sides of aorta
phased array has standoff but better able to see all sides
5 views of epiaortic exam
sax prox asc - stj - prox pa
sax mid asc -adjacent to right pa
sax distal asc - r pa to innominate
lax asc ao
lax arch
Grading plaque
grade 1 normal intimal thickening
grade 2 severe thickening without protruding atheroma
grade 3 3-5 mm atheroma
grade 4 >5 mm atheroma
grade 5 anything mobile
changes made due to epiaortic ultrasound
convert to off pump cabg
circulatory arrest
change cannulation, clamp position
repair / replace aorta
use heart string
only use LIMA
Why epiaortic us may not be used
time
risk of contamination
will information change procedure? Make procedure more harmful?
epicardial us exam
when TEE may be contraindicated or unfavorable risk benefit
Images for epicardial exam
av short axis
av long axis
lv basal sax
lv mid sax
lv lax
LV 2 chamber - hard to get
Edwards sapien vs medtronic corevalve
sapien is balloon expandable bovine pericardium.
Medtronic is self expandable nitinol porcine pericardium suprannular valve design and larger EOA
catheter mitral valve procedures
TMVR no current fda approved devices (can use sapiens series)
mitraclip - XTR and NTR
LAA occlusion
watchman - percutaneous via transeptal puncture.
lariat
most common complication of watchman
tamponade/effusion
Area for transeptal puncture
in fossa ovalis, but exact location can vary per type of procedure.
For mitraclip, posterior and mid superior
FOr LAAO watchman posterior and mid inferior
