Bài giảng Siêu âm tim 3D trong đánh giá và can thiệp các bệnh lý van tim – TS.BS. Nguyễn Thị Thu Hoài

SIÊU ÂM TIM 3D TRONG ĐÁNH GIÁ VÀ CAN
THIỆP CÁC BỆNH LÝ VAN TIM

TS.BS.NGUYỄN THỊ THU HOÀI
VIỆN TIM MẠCH QUỐC GIA VIỆT NAM


4D echocardiography, history and actual performance. How to
implement it to your routine echo lab


3D Echocardiography 2015: State of the Art

TEE: AS diagnosis quantitative
TTE: Pacemaker leads
TTE and TEE: AC
•
•
•
•
•
•

LV
AS
MR
LAA
ASD
TR

Volume, Mass, radial, longitudinal, twist, torsion

TAVI, preinterventional, intra-, postprocedural, complications
differential diagnosis MitraClip®, Cardioband ®, parav. leak
preinterventional, intraprocedural
preinterventional, intraprocedural
preinterventional, intraprocedural


LỰA CHỌN VÀ ĐÁNH GIÁ BỆNH NHÂN KẸP
SỬA VAN HAI LÁ QUA DA MITRACLIP -

CẬP NHẬT VỀ VAI TRÒ CỦA SIÊU ÂM TIM 3D
QUA THỰC QUẢN 3D

Select and assess patients for MitraClip:
Update on the roles of 3D TEE


Echocardiography is a key modality for MR

Etiology
Severity
Symptom
LV function

Echo
Echo
I nterview ing
Echo

2

Mitral Valve Anatomy
Leaflet
l Annulus
l Chordae
l Papillary muscle
l


MitraClip anatomical patient selection
considerations
Recommended criteria1
•
•
•
•
•
•
•
•

Moderate to severe MR
(Grade 3 or more out of 4 grades)

Pathology in A2-P2 area
Coaptation length > 2 mm
(depending on leaflet mobility)
Coaptation depth < 11 mm
Flail gap < 10 mm
Flail width < 15 mm
Mitral valve orifice area > 4cm2
(depending on leaflet mobility)
Mobile leaflet length > 1 cm

FMR

DMR

1. The current patient considerations are based on EVEREST II and
commercial European experience to date. The MitraClip Patient
Selection Coniderations document has been endorsed by Expert
Opinion (Crossroads institute).



How to identify suitable patients?
1.

Anatomic criteria.

2.

Clinical criteria

EVEREST II: need to select patients with potential
clinical benefit.


Patient groups in which significant
clinical benefits have been reported
1.

Severe heart failure, despite optimal medical
therapy.

2.

CRT non-responders.

3.

Degenerative MR, denied for surgery.

4.

Severe LV dysfunction, refractory to medical
therapy.



Mitral valve suitability for Mitraclip

3D TEE

LA perspective
Surgeon’s view

Ao

Easy way
for understanding
the MV anatomy

P3

P1
P2

4


VGHTPE-019

Barlow’s MV with severe MR
and Bi-ventricular Failure Mild LV
AV

at 2016/6)

Flail A2 & A3

Prolapse A1

LAA

IAS

Prolapse P3


The changing appearance of the
MitraClip candidate:

Imaging is the key!




4ch

2D TEE for the mitral valve
P2

135°

AML

Bicommisure view

A2
P3
LAA

45°

P1

Long axis

P2

A2

0°
3