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1、Cardiac Ultrasound Technology and Mitral ValvuloplastyHE Yihua, LI ZhianHE Yihua, LI ZhianBeijing Anahen Hospital, Capital Medical University Beijing Anahen Hospital, Capital Medical University 心脏超声波诊断技术及二尖瓣成形术（英文）n nMitral apparatusMitral apparatus：annulusannulus、leafletsleaflets、chordae tendineaec
2、hordae tendineae、papillary musclepapillary musclel lSaddle shape of annulusSaddle shape of annulus，the the highest point in the antero-highest point in the antero-posteriorposterior，the lowest point in the lowest point in the medial-lateralthe medial-laterall lCarpentier anatomic descriptionCarpenti
3、er anatomic descriptionl lThree orders of chodae Three orders of chodae tendineaetendineaeAnatomy of MV 心脏超声波诊断技术及二尖瓣成形术（英文）Echo features of RMSuuMost common in the Most common in the adult adult （99%99%） uuThickened leaflets; Thickened leaflets; adhesion of adhesion of commissurecommissure; ; contr
4、action of contraction of chordaechordae tendineaetendineae uuSecondary Secondary calcificationcalcification（most in most in the edgethe edge）uuMultiple leaflets Multiple leaflets involvedinvolved心脏超声波诊断技术及二尖瓣成形术（英文）正常 MitralMitral valve thickening valve thickening、calcificationcalcification、restrict
5、ed motionrestricted motion PMLPML and AML: and AML: equidirectionalequidirectional motion; motion; city wall changescity wall changes Decreased EF-slope Decreased EF-slope （non-specific non-specific findingfinding） M-mode “A” peak wave disappearedM-mode “A” peak wave disappeared Doming signDoming si
6、gn心脏超声波诊断技术及二尖瓣成形术（英文）Echo diagnostic key points of balloon mitral valvuloplastyn nSeverity of MSSeverity of MSn nMVA1.5cm2 MVA5mmHgPGmean5mmHgn nSeverity of MRSeverity of MRn nCombined valve disease or anomalyCombined valve disease or anomalyn nMitral valve conditionsMitral valve conditionsn nDegre
7、e of mobility and calcificationDegree of mobility and calcificationn nNo commissure calcificationNo commissure calcificationn nNo subvalvular chordal shorteningNo subvalvular chordal shorteningn nAt rest: SPAPAt rest: SPAP50mmHg50mmHgn nAt stress: PGmean At stress: PGmean 15mmHg 15mmHg SPAP SPAP 60m
8、mHg60mmHg心脏超声波诊断技术及二尖瓣成形术（英文）Echo evaluation for MR 心脏超声波诊断技术及二尖瓣成形术（英文）n nEtiolotyn nSeverity n nLocation n nSecondary changes n nLV function Echo key point for therapeutic determination心脏超声波诊断技术及二尖瓣成形术（英文）Etiology vs. therapeutic planningRheumatic Ischemic Mitral prolapseChordal ruptureMyxomatous
9、degenerationValve replacement Excision of PMLChordal replacementArtificial chordaeEdge to edge repairLV reconstructionAnnuloplasty心脏超声波诊断技术及二尖瓣成形术（英文）Echo diagnosis for etiology of mitral diseases心脏超声波诊断技术及二尖瓣成形术（英文）Classification and EtiologyNormal LeafletMotionRestricted Leaflet Motion Excess Leaf
10、let Motion 心脏超声波诊断技术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）TYPENormal Leaflet MotionNormal valvular motionLeaflet perforation or Cleft valve心脏超声波诊断技术及二尖瓣成形术（英文）n nTYPETYPE Excess Leaflet Motion Excess Leaflet Motion Myxomatous degenerationMyxomatous degeneration Lack of fibrous frameworkLack of fibrous fram
11、ework Chordal ruptureChordal rupture心脏超声波诊断技术及二尖瓣成形术（英文）Chordal rupturen nChordal ruptrueChordal ruptruen nFlail motionFlail motionn nEccentric regurgitationEccentric regurgitation心脏超声波诊断技术及二尖瓣成形术（英文）Mitral prolapseMVP :MVP : Eccentric regurgitationEccentric regurgitation心脏超声波诊断技术及二尖瓣成形术（英文）Valve de
12、generationValve degenerationCVMDPCVMDFiber loss of elastic tissue diseaseCalcificationSCVMD心脏超声波诊断技术及二尖瓣成形术（英文）PHVMD definitiondefinition： Descripted firstly by Rippe et Descripted firstly by Rippe et al in 1980al in 1980 P Pathologiesathologies MD in the fibrous layer MD in the fibrous layer Dissol
13、veDissolve RuptureRupture MucopolysaccharideMucopolysaccharide Protein accumulationProtein accumulation No calcificationNo calcification No severe fibrosisNo severe fibrosis Predominantly involved mitra Predominantly involved mitra valvevalve心脏超声波诊断技术及二尖瓣成形术（英文）Echo findingsEcho findings ValveValve
14、ThicknessThickness RedundancyRedundancy FloppyFloppy Billowing or ballooning Billowing or ballooning ProlapseProlapse Secondary changesSecondary changes： RegurgitationRegurgitation, chordal rupture, chordal ruptureMyxomatous degeneration心脏超声波诊断技术及二尖瓣成形术（英文）Combined valvular involvement心脏超声波诊断技术及二尖瓣成
15、形术（英文）Thickening, floppy, redundancy of mitral valve心脏超声波诊断技术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）Evalve MitraClipDeployPosition and Grasp心脏超声波诊断技术及二尖瓣成形术（英文）TYPE Restricted Leaflet Motion(RLM)RLMRHDPapilary muscle displacementValvular disease per seSymmetric DCMDissymetric IMR心脏超声波诊断技术及二尖瓣成形术（英文）心脏超声波诊断技
16、术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）CoronaryCoronarySinusSinusReshapingReshapingCoronary Sinus AnnuloplastyCoronary Sinus Annuloplasty-Edwards Monarch-Cardiac DimensionsCarillon-Viacor PTMA*Direct Annulus PlicationDirect Annulus Plication-Mitralign-Guided Delivery SystemsPosteriorPosteriorAnnularAnnular
17、ReshapingReshapingCoronary Sinus- Coronary Sinus- Atrial ReshapingAtrial ReshapingLeft Ventricular Shape Left Ventricular Shape ChangeChange-Myocor (Surgical/Perc) Trans-Atrial Shape ChangeTrans-Atrial Shape Change -Ample PS3 SystemDeviceDeviceSchematicSchematicMechanismMechanismLV Antero-LV Antero-
18、Posterior Posterior ReshapingReshapingCurrent Percutaneous Technology for Functional MR心脏超声波诊断技术及二尖瓣成形术（英文）n nImplants consist of two epicardial pads Implants consist of two epicardial pads connected by a flexible sub-valvular chordconnected by a flexible sub-valvular chordn nSurgical device=Intrape
19、ricardial deviceSurgical device=Intrapericardial deviceMitral valveRight VentricleAnterior PadSub-valvular chordLeft VentriclePosterior PadCoapsys ImplantiCoapsys ImplantMyocor Transpericardial Mitral Repair心脏超声波诊断技术及二尖瓣成形术（英文）Myocor Transpericardial Mitral RepairCourtesy of Wes Pederson, Abbott, Mi
20、nneapolis, Minnesota.心脏超声波诊断技术及二尖瓣成形术（英文）Echo diagnosis for location of mitral diseases心脏超声波诊断技术及二尖瓣成形术（英文）Echo diagnosis for location of mitral diseasesTEE心脏超声波诊断技术及二尖瓣成形术（英文）TEEEcho diagnosis for location of mitral diseases心脏超声波诊断技术及二尖瓣成形术（英文）TEEEcho diagnosis for location of mitral diseases心脏超声波诊
21、断技术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）3-Dimensional echo and intraoperative findings Echo diagnosis for location of mitral diseases心脏超声波诊断技术及二尖瓣成形术（英文）Echo quantification for severity of mitral disease心脏超声波诊断技术及二尖瓣成形术（英文）Quantification of MR心脏超声波诊断技术及二尖瓣成形术（英文）Jet length: 、Quantification of MR心脏超声波诊断技术及
22、二尖瓣成形术（英文）PISA methodERO = (2rERO = (2r2 2 x V x VPISAPISA) / MR-V) / MR-VmaxvmaxvRV = ERO X MRRV = ERO X MRTVITVIQuantification of MR心脏超声波诊断技术及二尖瓣成形术（英文）Development of 3D EchoIntraoperative locationStudy of annular functionStudy of ERO心脏超声波诊断技术及二尖瓣成形术（英文）Signification of studying annular morphology
23、Functional MROrganic MRChanges of annular morphology and functionOptimal surgical procedure 心脏超声波诊断技术及二尖瓣成形术（英文）Current status of mitral annular studyRadioactive material labeledAnimal experiment Invasive study心脏超声波诊断技术及二尖瓣成形术（英文）Measurement variables Height Projection areaM-A Antero-posterior diame
24、terLongitudinal Displacement and velocity of annulus心脏超声波诊断技术及二尖瓣成形术（英文）IMR MVPAnnulus flattened、increased Antero-posterior diameter穹隆体积增加穹隆体积增加No obvious change of annular shape心脏超声波诊断技术及二尖瓣成形术（英文）Dynamic change of 3D-MVA During a cardiac cycle0.000.180.360.720.90心脏超声波诊断技术及二尖瓣成形术（英文）3D analysis of
25、mitral valven nCoaptation area and indexCoaptation area and indexCoaptation index= =Surface area in early diastole Surface area in late systoleSurface area in early diastoleCoaptation area心脏超声波诊断技术及二尖瓣成形术（英文）Coaptation area and index心脏超声波诊断技术及二尖瓣成形术（英文）Coaptation area and index心脏超声波诊断技术及二尖瓣成形术（英文）Qu
26、antification of tenting volume心脏超声波诊断技术及二尖瓣成形术（英文）Intraoperative monitoring心脏超声波诊断技术及二尖瓣成形术（英文）Complications of annuloplastyn nResidual MRResidual MRn nResidual or new MSResidual or new MSn nSAMSAM or prosthetic strut protrusion with LVOT or prosthetic strut protrusion with LVOT obstructionobstructi
27、onn nLeft or right ventricular dysfunctionLeft or right ventricular dysfunctionn nCoronary occlusion from annuloplasty or valve ring Coronary occlusion from annuloplasty or valve ring suturesuturen nPseudoaneurysm formation at site of debridement of Pseudoaneurysm formation at site of debridement of
28、 mitral annular calcificationmitral annular calcificationn nShunts related endocarditis Shunts related endocarditis n nAR secondary to suture placement or annular distortionAR secondary to suture placement or annular distortionn nEmbolism eventsEmbolism events心脏超声波诊断技术及二尖瓣成形术（英文）3D TEE Pre-Procedure心脏超声波诊断技术及二尖瓣成形术（英文）After anesthesiaAfter anesthesiaBefore anesthesiaBefore anesthesiaEvaluation for MR at different status心脏超声波诊断技术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）心脏超声波诊断技术及二尖瓣成形术（英文）
