Transesophageal ECHO and the Mitral Valve Anesth Analg 1999;88:1205–12.

Apresentação em tema: "Transesophageal ECHO and the Mitral Valve Anesth Analg 1999;88:1205–12."— Transcrição da apresentação:

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2 Transesophageal ECHO and the Mitral Valve

3 Anesth Analg 1999;88:1205–12.

4 Am Heart J. 2000;139: 378-87.

5 Fibrous Skeleton Of The Heart

6 Ann Thorac Surg 1998: 65:1025-1031. J Heart Valve Dis 1995; 4:70-75. Cardiol Clin. 2000; 18: 731-50. Anatomic Classification Schema: Mitral Valve Segments Duran Classification

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10 JASE. 2003; 16: 61 – 66.

11 Mid-esophageal 4C View A3 and A1 Commisural View P3-A2-P1 Two Chamber View P3-A1 Long Axis View A2 Transgastric Views (Short) Posteromedial commissure Anterolateral commissure Transgastric Views (Long) Chordae Tendinae Papillary Muscle Assessment of the Mitral Valve JASE. 2003; 16: 61 – 66.

12 Anesth Analg 1999;88:1205–12. Mid-esophageal Views (Transducer @ 0°)

13 Cardiol Clin. 2000; 18: 731-50. Four Chamber Views: Isolating Mitral Valve Leaflet Segments

14 Crit Care Clin. 1996; 12: 321-81. Four Chamber View

15 Anesth Analg 1999;88:1205–12. Mid-esophageal Views (Transducer @ ~60°)

16 Cardiol Clin. 2000; 18: 731-50. Two Chamber Views: Isolating Mitral Valve Leaflet Segments

17 Crit Care Clin. 1996; 12: 321-81. Two Chamber: Posterior View

18 Apical Long Axis View Cardiol Clin. 2000; 18: 731-50.

19 Commissural View JASE. 2003; 16: 61 – 66. Flail lateral scallop

20 Commissural View Flail medial scallop JASE. 2003; 16: 61 – 66.

21 Anesth Analg 1999;88:1205–12. Transgastric Views (Transducer @ 0°)

22 Cardiol Clin. 2000; 18: 731-50. Transgastric Long-axis View: Visualization of the Papillary Muscles Posteromedial Papillary Muscle Anterolateral Papillary Muscle

23 JASE.1998;11:966-71. Accuracy of Transesophageal Echocardiographic (TEE) Diagnosis in Determination of Affected Flail Leaflet Affected LeafletnTEE diagnosisAccuracy (%) Anterior 66100 Posterior 45 100 Bileaflet 3133 Total545296

24 JASE.1998;11:966-71. Accuracy of Transesophageal Echocardiographic Diagnosis of Affected Scallop Among Patients With Posterior Flail Mitral Leaflet Affected Scallop Identified n Sensitivity (%) Specificity (%) Overall accuracy (%) Middle (P2)3482 Lateral (P1)71008990 Medial (P3)1050*10090 Total51789288

25 JASE. 2003; 16: 61 – 66. Diagnostic Accuracy of Identification of Mitral Regurgitant Defects by Correlation with Surgical Findings Defect LocationSensitivity (%)Specificity (%) A1 97.1 98.3 A2 96.3 97.7 A3 98.5 97.9 P1 98.7 97.8 P2 99.6 92.4 P3 94.7 96.9

26 Frequency of Valve Repair According to Location of Flail Leaflet and Scallop JASE.1998;11:966-71. Locationn Repaired (n) Repaired (%) Posterior453067 Middle282071 Medial55100 Lateral5360 Multiple4125 Not specified3133 Anterior600 Bileaflet3267 Total543259

27 Pathologic Anatomic Changes to Assess During Transesophageal Echocardiographic Examination of the Mitral Valve Calcification Dilatation Perivalvular Leak (Prosthetic Valves) Mitral Annulus

28 Cardiol Clin. 2000; 18: 731-50. Midesophageal View of the Mitral Valve Mitral Annular Calcification Mitral Annular Calcification

29 Circulation. 2000;101:695.

30 Mitral Leaflets Billowing leaflet Coaptation level of anterior and posterior leaflet relative to annulus Systolic anterior motion of anterior leaflet Leaflet thickening Leaflet fusion (rheumatic); doming of fused leaflets in diastole (mitral stenosis) Calcification of leaflets Prolapse Deformation of leaflet free margin Thickening, retraction of free margin into ventricle (curling under) Endocarditis Vegetation, leaflet aneurysm, perforation, associated regurgitant jet of aortic insufficiency hugging ventricular side of anterior leaflet (possible source of infectious seeding)

31 Circulation. 2000;102:1400.

32 Apical Displacement of Mitral Coaptation (aka “Tenting”)

33 Cardiol Clin. 2000; 18: 731-50. Mitral Valve Prolapse Classic MVP Displacement > 2 mm Thickness ≥ 5 mm Non-Classic MVP Displacement > 2 mm Diagnostic Criteria

34 Atrial Views of Prolapse of the Anterior Mitral Valve Leaflet

35 ChordaeChordae Chordal systolic anterior motion Thickening Fusion Calcification Elongation Rupture

36 Cardiol Clin. 2000; 18: 731-50. Posterior Mitral Leaflet Prolapse (Flail Posterior Leaflet) Ruptured Chord

37 Papillary Muscles Ruptured papillary muscle LV-papillary muscle dysfunction

38 Cardiol Clin. 2000; 18: 731-50. Subtotal Ruptured Papillary Muscle

39 MiscellaneousMiscellaneous Miscellaneous Findings Left atrial enlargement Atrial appendage thrombus, LV dilation/aneurysm, TV annulus dilation, tricuspid regurgitation, right ventricular enlargement Systolic anterior motion Mitral valve repair Narrow LVOT Small LV diameter Increased anterior and posterior leaflet area

40 Am Heart J. 1996; 131: 162-76. Post-Operative Assessment: Residual Mitral Regurgitation Before And After

41 Cardiol Clin. 1998; 16: 477-89. Post-Operative Assessment: Residual Mitral Regurgitation Before And After

42 Crit Care Clin. 1996; 12: 321-81. Post-Operative Assessment: Exclude Systolic Anterior Motion of the Mitral Valve

43 Crit Care Clin. 1996; 12: 321-81. Post-Operative Assessment: Exclude Mitral Stenosis

44 Anesth Analg 1999;88:1205–12.