06 Perc MV Repair - Office 365

Percutaneous MV Repair

Steven A. Goldstein MD FACC FASE Professor of Medicine Georgetown University Medical Center MedStar Heart Institute Washington Hospital Center Monday, October 10, 2017

DISCLOSURE

I have N O relevant financial relationships

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3D-TEE in Mitral Interventions

? Surgical mitral valve repair (Operating Rm) ? Edge-to-edge repair of mitral regurgitation ? Transcatheter MV insertion (TMVI)(e.g.,Tendyne) ? Closure of paravalvular mitral regurgitation ? Valve-in-valve implantation ? Balloon mitral valvuloplasty (mitral stenosis)

Echo for MV Disease

? Mitral valve anatomy/pathology

Mechanism(s) of MV disease

? Quantitation of MR ? Procedural guidance

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Unlike AS singular pathology MR highly variable etiologies

MV anatomy/pathology

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Mitral Valve Apparatus

Dilatation Left atrium

Annulus

Leaflets

Chordae tendinae

Papillary muscles

LV free wall

Dilatation Calcification Prolapse Redundancy Thickening Perforation Cleft Commissural fusion Abnormal insertion Elongation Rupture Thickening/fusion Ischemia Fibrosis Rupture Lateral displacement (ischemia, fibrosis, dilatation)

Inter-commissural distance Aorta

Septo-Lateral distance

Coapt Displ

Tent Vol

Tenting Height Coaptation length

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Leaflet Overlap

(coaptation length)

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Tenting area

Coaptation depth

Leaflet overlap

Mechanisms of Mitral Regurgitation

Normal

Apical Tethering

Prolapse

Restricted PML

Dilated anulus Ruptured pap muscle

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Ruptured cords

Case 1

Ruptured cords P2

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Case 2

Ruptured cord P2

MVP

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