Cardiacimagingin’’ valvularheartdisease€¦ · Estenosis mitral planimetría. Gradación...
Transcript of Cardiacimagingin’’ valvularheartdisease€¦ · Estenosis mitral planimetría. Gradación...
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Cardiac imaging in valvular heart disease
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• 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
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Normal valvular echo: mitral valve
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Abnormal Mitral Valve
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Ecocardiografia Tridimensional
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TTE: Echo anatomy of the TV
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TEE: Mid-esophag. 4ch. view of TV
sept
ant
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ant
post
sept
TEE: Transgastric transv. view of TV
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Normal valvular echo: aor6c valve
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Vahanian A et al Eur Heart J 2008
Aor6c root anatomy
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Valve morphology
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Normal valvular echo: pulmonary valve
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Valve Stenosis
• Doppler :increased transvalvular gradient • Reduced effec6ve valvular area
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gradiente medio: 6 mmHg
Estenosis mitral Doppler CW espectral
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• Pressure half 6me • Mean transvalvular gradient
Quan6fica6on of valve stenosis
PHT 220 ms = 1 cm2
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Estenosis mitral planimetría
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comisura post
comisura ant
Área : 1.2 cm2
VI
va
vp
Estenosis mitral planimetría
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Gradación estenosis mitral
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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
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Valve Regurgita6on
Turbulent abnormal flow (non-‐laminar)
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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
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insuficiencia mitral
Ligera Severa
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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
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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
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Assessment of VR: Color Doppler jet area
Advantages
EASY
• Simple
• Quick
• Easy interpretation
• Spatio-temporal direction of jet
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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
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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
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Mitral mechanical prosthesis: TTE
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Mitral mechanical prosthesis: TEE
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Doppler/hemodynamic profile
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2D echo bioprosthesis
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• Anterior dehiscence near leZ atrial appendage
Paravalvular Leaks: Abnormal
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Normally functioning valve prosthesis?
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