3D echocardiography in diagnosis of cardiovascular disease
Introduction
3D Echocardiography was introduced after the
year 2000.
Fully sampled matrix array transducers .
Live 3D, 3D Zoom and Full Volume modes.
Used to select and guide the most appropriate
intervention during BMV, MitralClip, TAVI
3D Echocardiography applied in diagnosis of
cardiovascular disease at MEDIC HCMC since
January 2012.
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3D ECHOCARDIOGRAPHY IN DIAGNOSIS OF CARDIOVASCULAR DISEASE Nguyen Tuan Vu MD PhD MEDIC HCMC PNT-U MAINZ University Introduction 3D Echocardiography was introduced after the year 2000. Fully sampled matrix array transducers . Live 3D, 3D Zoom and Full Volume modes. Used to select and guide the most appropriate intervention during BMV, MitralClip, TAVI 3D Echocardiography applied in diagnosis of cardiovascular disease at MEDIC HCMC since January 2012. Patients & Methods -Pts with 3D TTE and 3D TEE at Medic HCM since January 2012 -Instrument: Phillip ie 33 3D TTE Probe 2 MHz and 3D TEE 5MHz Probe -Techniques: 2D X plane, Live 3D, 3D Zoom, Full Volume - Case series report study - Compare the diagnosis before and after intervention or operation. 3 D Echocardiography Fully sampled Matrix- Array Transducer 3000 Piezoelectric Elements TTE 2-4MHz TEE 5-7MHz Data Acquisition Live 3 D : real time 3 D mode, narrow sector Full volume: gated acquisition Zoom 3D: focused wide sector Results 20% 44% MR, chordea rupture Bicuspid Aorta Coronary Fistula Mechanical Valve Endocarditis Myxoma Aortic Dissection Philips IE 33 Mitral Stenosis Advantages of 3D Echocardiography Visualize the entire MV and associated structures More reliable Planimetry of the mitral orifice by using MPR. Detection of complicated commissural fusion. The 3 D dataset may be oriented to view the MV from the surgeon view. Leaflet mobility particularly well analyzed in the 3D Zoom mode. More sensible in detecting LA and LAA Thrombi. Monitor and guide the catheter during BMV. Mitral Regurgitation Anatomical detail of MV Clip 1 Echocardiographic Anatomy Mitral leaflets TEE and surgeon view Normal MV fr LA view MS: 3D TTE LAX View SAX View MS: 3D TTE Apical 4 C View Live 3 D with color MS, LAA Thrombus Mitral Stenosis 3D Zoom Clip 3 D Zoom LA Thrombus I crop LA Thrombus LAA Thrombus Normal LAA LAA Thrombus Guide the catheter during BMV Fluoroscopy Live 3D Echocardiography Mitral Regurgitation Mitral Regurgitation Mitral Regurgitation 3D Zoom 3D Live with color Mitral Regurgitation Mitral Regurgitation: 2 Jets Graduation of MR: PISA Method Mitral Regurgitation 3D ECHOCARDIOGRAPHY Mechanism of MR. Graduation: Vena Contracta, MR Volume ( PISA 2D, 3D ). Detection of multiple Jets. Location of lesion: segment I,II,III Monitoring MitralClip procedure Criteria for MitralClip : functional MR, segment II, PML <10mm . Guiding septal puncture and MitralClip Follow up next to MitralClip Mitral Regurgitation 2D TTE.MR 2D TTE. Color 3D TTE. Zoom 2D TEE 2D TEE Color Live 3D 3D TEE Color 3D TEE Color. 3D TEE Zoom 3D TEE Zoom. Mitral Clip Mitral Clip 2D Mitral Clip 3D Transcatheter Aortic Valve Implantation ( TAVI ) Optimal Treatment for high risk Pts with severe symptomatic AS. 3 D Echocardiography play a role both in patient selection process and monitoring technique during TAVI. Clip Core Valve Clip Edwards Edwards and CoreValve STUDY AORTIC VALVE: LIVE 3D Echocardiography Diastole Systole 2D& 3D Measurements before TAVI Asc. Aorta Measure AVA by use of QLAB 3D Echocardiography prior and next to TAVI Study aortic cusps , SAX Study aortic cusps , LAX Apical 5C View, 2D Apical 5C View, 3D Apical 3C View, 3D with color Mechanical Prostheses ( 3D Zoom ) Mitral Prosthetic MR, 2D TEE Intraprosthetic MR Atrial septal defect Ostium secundum ASD Icrop 3D 3D Zoom RPV visualization ASD rim measurement SVC & IVC MV AO Rim in 3D Live 3D TEE Without color With color RA LA ASD Sinus venosus ASD Sinus venosus ASD SVC sinus venosus ASD SVC sinus venosus ASD. 3D Multiple ASD Multiple ASD 2 D Multiple ASD 3D Multiple ASD 2D color Multiple ASD 3D color IVC sinus venosus ASD Multiple ASD LA Myxoma ASD Ostium II 2D Echocardiography 3D Echocardiography TEE 2D TEE 2D Color TEE 3D without color TEE.3D.Color TEE.3D Color.1 TEE.3D.Color.2 TEE.3D.Color.3 TEE.3D.Color.4 TEE 3D Zoom Device closure Device closure.1 Other cardiopathies Bicuspid Aorta Thrombose of Descending Aorta TAVI Procedure PFO Closure Watchman Device Myxoma Discussion & Conclusion Intervention cardiac procedure rely on various imaging modality for their safety and efficacy. Three-dimensional Echocardiography with good spatial resolution provides a perspective real-time 3D imaging that has several advantages in assessing valvulopathies, ASDs and other cardiopathies to choice properly Pts, devices and techniques ( BMV, TAVI, MitralClip, ASD closure ). This new method makes exactly the diagnosis of cardiopathies before intervention, follows up during and next to procedure. 3 D Echocardiography associated with fluoroscopy guides the interventional procedure, reduces the interventional complications. References Braunwald’ s Heart Disease, 9th Ed, Elservier Saunders 2012. David Sidebotham, Practice Perioperative Transesophageal Echocardiography,2nd Ed, Elservier Saunders 2011. Catherine Otto, The Practice of Clinical Echocardiography, 4th Ed, Elservier Saunders 2012. Feigenbaums’ Echocardiography, 7th Ed, William Wilkins 2010. Topol, Textbook of Interventional Cardiology, 5th Ed, Elservier Saunders 2008. Vielen Dank !
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