cardiacimagingin’’ valvularheartdisease€¦ · estenosis mitral planimetría. gradación...
TRANSCRIPT
Cardiac imaging in valvular heart disease
• Morphological and func6onal anatomy
• Quan6fica6on of dysfunc6on
• Hemodynamic impact of VHD
• Therapeu6c and prognos6c implica6ons: 6ming interven6on
• Guiding therapy: surgical or percutaneous interven6ons
Cardiac imaging in VHD
Normal valvular echo: mitral valve
Abnormal Mitral Valve
Ecocardiografia Tridimensional
TTE: Echo anatomy of the TV
TEE: Mid-esophag. 4ch. view of TV
sept
ant
ant
post
sept
TEE: Transgastric transv. view of TV
Normal valvular echo: aor6c valve
Vahanian A et al Eur Heart J 2008
Aor6c root anatomy
Valve morphology
Normal valvular echo: pulmonary valve
Valve Stenosis
• Doppler :increased transvalvular gradient • Reduced effec6ve valvular area
gradiente medio: 6 mmHg
Estenosis mitral Doppler CW espectral
• Pressure half 6me • Mean transvalvular gradient
Quan6fica6on of valve stenosis
PHT 220 ms = 1 cm2
Estenosis mitral planimetría
comisura post
comisura ant
Área : 1.2 cm2
VI
va
vp
Estenosis mitral planimetría
Gradación estenosis mitral
Quantification of aortic stenosis
Area (cm2)
Area/BSA (cm2/m2)
Mean ∆P (mmHg)
V max (m/s)
Mild > 1,5 > 1,0 > 25 < 3
Moderate 1,0-1,5 0,6-1,0 25-50 3-4
Severe < 1,0 < 0,6 > 50 > 4
Bonow ACC/AHA Guidelines 2006 Vahanian A et al. ESC Guidelines, 2007
Valve Regurgita6on
Turbulent abnormal flow (non-‐laminar)
Evaluación IM: Doppler Color
Spain MG et al. J Am Coll Cardiol 1989;13:585. Castelló R et al. J Am Coll Cardiol 1992;19:1516
ligera < 4 cm2 severa > 8 cm2
insuficiencia mitral
Ligera Severa
Grading of AR: Methodology
• Mild AR: jet diameter <30% LVOT width • Moderate AR: jet diameter 30-‐50% LVOT width • Severe AR: jet diameter > 50% LVOT width
Assessment of MR: Color Doppler jet area
Spain MG et al. J Am Coll Cardiol 1989;13:585. Castelló R et al. J Am Coll Cardiol 1992;19:1516
mild < 4 cm2 severe > 8 cm2
Assessment of VR: Color Doppler jet area
Advantages
EASY
• Simple
• Quick
• Easy interpretation
• Spatio-temporal direction of jet
Volumetric methods: - Quantitative Doppler - 2D echo
Direct methods: - PISA
Quantitative methods to assess VR
« Recommendations for evaluation of the severity of native valvular regurgitation with 2D and Doppler echocardiography » Zoghbi et al. Eur J Echocardiography.2003;4:237-61
GRADE Regurg. Vol. (ml/beat)
Regurg. Fraction (%)
ROA (mm2)
I < 30 < 30 < 20
II 30-45 30-50 20-35
III 45-60 50-60 35-45
IV >60 >60 > 45
Organic MR
Mitral mechanical prosthesis: TTE
Mitral mechanical prosthesis: TEE
Doppler/hemodynamic profile
2D echo bioprosthesis
• Anterior dehiscence near leZ atrial appendage
Paravalvular Leaks: Abnormal
Normally functioning valve prosthesis?