Valve Repair/Replacement Flashcards
What are the 3 repairs for Mitral Regurgitation?
- transcatheter mitral clip
- transcatheter annuloplasty
- surgical MVP repair
What is done during a TRANSCATHETER MITRAL CLIP REPAIR?
The clip is introduced into LA and positioned above leaflets and then advanced into LV below the valve leaflets & retracted & close to hold leaflets together to reduce MR
What is done during a TRANSCATHETER ANNULOPLASTY?
D shaped ring that utilizes a unique time saving anchoring mechanism
What is done during a SURGICAL MVP REPAIR?
involves a triangular resection of the sagging scallop and typically followed by an annular ring
How does an ANNULAR RING appear on Echo?
echogenic and slightly increased velocities through the ring
What are the types of repair for Mitral Stenosis?
- catheter balloon
- surgical valvotomy
What are the types of repair for Aortic Insufficiency and Stenosis?
valve is typically replaced. no repaired because of location being adjacent to aorta
What are the types of PROSTHETIC VALVES?
- Bioprosthetic “ Tissue” Valves
1a. Stented
1b. Stentless
1c. Catheter - Homograft Valves
- Autograft Valves
- Valve Conduits
- Mechanical
5a. Bileaflet
5b. Tilting disk
What is the COMPOSITION of BIOPROSTHETIC TISSUE VALVES?
Referred to as heterografts (tissue from animal to human) leaflets typically porcine, or pericardium usually bovine or equine shaped to mimic normal leaflets
What is the SUPPORT STRUCTURE of A STENTED TISSUE VALVE?
mounted on a cloth-covered rigid support ring with a raised stent at each of the 3 commissures
What is the SUPPORT STRUCTURE of a STENTLESS VALVE?
uses a flexible cuff of fabric or tissue, instead of rigid stents to support the valve leaflets
What is the SUPPORT STRUCTURE of a CATHETER VALVE?
special designed bioprosthetic valves that can be implanted by a transcatheter approach with the tissue leaflets mounted on a compressible stent
What is the COMPOSITION of HOMOGRAFT VALVES?
cryopreserved human aortic or pulmonic valves harvested at autopsy. (human to human)
What is a homograft preserved as and what is it prone too?
- as a block ie., valve with portion of great vessel known as a valve conduit
- severe tissue calcification
What is the COMPOSITION of MECHANICAL VALVES?
made of carbon or titanium
What is the COMPOSITION of BILEAFLET MECHANICAL VALVE?
two semicircular disks hinged on a sewing ring
What is the COMPOSITION of TILTING DISK MECHANICAL VALVE?
a single circular disk supported on a central strut running across the sewing ring
Describe the ROSS PROCEDURE
is a autograft procedure (self to self donation) where AV is replaced with child’s own PV and a homograft is put into PV position
What is an ADVANTAGE and DISADVANTAGE of Bioprosthetic Tissue Valves?
- Advantage: do no require anticoagulation therapy
- Disadvantage: average longevity 10 years due to degenerative calcific process
What is an ADVANTAGE and DISADVANTAGE of Mechanical Valves?
- Advantage: longevity due to durability
- Disadvantage: lifelong anticoagulation therapy: traditional method is warfarin
What is bioprosthetic tissue valve REGURGITATION OR STENOSIS due to?
- due to fibrotic changes to the leaflets, resulting in resistance to opening (stenosis) or failure to coapt (regurgitation)
What is mechanical valve REGURGITATION OR STENOSIS due to?
- due to thrombus formation or pannus ingrowth around the valve, thus impairing disk excursion or closure
How does NORMAL REGURGITATION appear on a bioprosthetic tissue valve?
have a small amount of central regurgitation
How does NORMAL REGURGITATION appear on a TAVR?
mild paravalvular
How does NORMAL REGURGITATION appear on a BILEAFLET MECHANICAL?
bileaflet valve closes, 2 crisscross jets of regurgitation from inner seams
How does NORMAL REGURGITATION appear on a TILTING DISK MECHANICAL?
occurs at closure line with major jet directed away from sewing ring at the edge of the major orifice
BOTH types of mechanical valves have what kind of regurgitation?
small regurgitant jets circumferentially
How does NORMAL REGURGITATION appear overall?
- tends to be uniform in color
- less in density and duration on CW
- originates from inside the sewing ring
- tends to be smaller and central
- degree of normal prosthetic regurg is greater than native valves
Where does PARAVALVULAR REGURGITATION occur?
- can occur with both bioprosthetic and mechanical valves
- occurs outside the sewing ring bc loss of suture material post op
What is PARAVALVULAR REGURG most often due to?
fibrocalcific disease in the valve annulus
What is DEHISCENCE?
major loss of sutures thus sewing ring is no longer adequately seated and the prosthesis rises off annulus
How can you witness DEHISCENCE?
evidenced by “rocking” motion of prosthetic
What is a frequent indication for echocardiography in patients with prosthetic valves?
endocarditis where bacterial migrate to abnormal tissue and foreign structures
How does endocarditis present on bioprosthetic tissue valves?
as vegetations
How does endocarditis present on mechanical valves?
as paravalvular abscess (pocket of infection separates valve from sewing ring causing paravalvular regurgitation)
How does a STENTED BIOPROSTHETIC appear on 2D?
- difficult to visualize the three tissue leaflets
- supporting structures typically echogenic - those with metal struts present as a “crown”
How does a STENTLESS BIOPROSTHETIC appear on 2D?
similar to that of a native aortic valve, other than increased echogenicity in the aortic root in the early post op period
How does a TAVR appear on 2D?
- increased echogenicity of the para-annular region is evident
- some longer supporting cage that extends into the LVOT or Ascending Aorta
How does a AORTIC HOMOGRAFT appear on 2D?
- appear similar to native aortic valves except for increased thickness in the LVOT and ascending aorta at the proximal and distal suture sites
How does a MECHANICAL VALVE appear on 2D?
severe reverberations and acoustic shadowing
How does a BIOPROSTHETIC VALVE appear on Doppler?
- prosthetic valve click on Doppler
- due to occluder/disk or tissue leaflets hitting the sewing ring
How does a MECHANICAL VALVE appear on Doppler?
- triangular shaped envelopes on Spectral Doppler
- tilting Disk: inflow tends to be slanted on color flow
What is BASELINE ECHO?
Echo done within 3 months (ideally 6-8 weeks post op) of valve implantation that serves as the baseline echo to which all subsequent echos can be compared
