Evaluation of hemodynamic characteristics of the saint jude prosthetic heart valve in the mitral position - Nguyễn Ngọc Hoàng Mỹ
RESEARCH QUESTION
OBJECTIVE OF STUDY
OVERVIEW
METHODS
RESULTS - DISCUSSION
CONCLUSIONS
RECOMMENDATIONS
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EVALUATION OF HEMODYNAMIC CHARACTERISTICS OF THE SAINT JUDE PROSTHETIC HEART VALVE IN THE MITRAL POSITION MD. MSc. NGUYỄN NGỌC HOÀNG MỸ Can Tho Central General Hospital Thanks to • Mentor: MD. PhD. Hồ Huỳnh Quang Trí • Place of research: Heart Institute of HCM city • Place of work: Can Tho Central General Hospital Declaration of Interest • No research funding • No stocks, investments, ownership, patents OBJECTIVE OF STUDY 2 OVERVIEW 3 METHODS 4 1 RESULTS - DISCUSSION 5 RESEARCH QUESTION 1 CONCLUSIONS 6 RECOMMENDATIONS 7 RESEARCH QUESTION 1 Rising population with Prosthetic mitral valve (PrMV) PrMV: quite new area Transthoracic echocardiogram (TTE): useful, precise, harmless Normal values of hemodynamic parameters of Saint Jude valve in mitral position on Doppler Echocardiography 1 Describe baseline clinical characteristics 2 Define structure and hemodynamic parameters of PrMV on Doppler Echocardiography 3 Compare difference of basic echo parameters in points of time Define normal values of hemodynamic parameters of the Saint Jude valve in mitral position 5 OBJECTIVE OF THE STUDY 2 6 Biological protheses: Autograft valve, Homograft valve, Xenogaft valve Types of Prosthetic heart valves OVERVIEW 3 Mechanical Prostheses Monoleaflet valve Bileaflet valve Ball-cage valve OVERVIEW 3 Methods to evaluate Prosthetic heart valves EOA 𝑃𝐻𝑇 = 220 PHT EOA CE = LVOT 𝑑 2 ∗ 𝜋 ∗ VTI LVOT 4 ∗ VTI MV VTI Ratio = VTI MV VTI(LVOT) EOAI = EOA BSA PPI = EOA GOA 8 RESEARCH METHODS 4 Objective of study Criteria for sample selection • Patients with Saint Jude mitral valve replacement followed up as outpatients and in stable clinical condition Criteria for exclusion • Aortic stenosis or aortic regurgitation ≥ 2/4 • Aortic valve replacement • Coronary stenosis or CABG with mitral valve replacement (MRV) • Congenital heart defect • Unstable clinical condition: tachycardia, angina, dyspnea, fever • Pleural effusion, pericardial effusion • PrMV complication after 02 months of observation RESEARCH METHODS 4 Research Methods 𝑛 ≥ 𝐶2𝑥 𝑆2 𝜀2 C= 2,09 (degree of freedom 19 và p= 0,05) Sample mean 1,85 cm2 Sample variance S2= 0,12 𝑋 and difference 5% = 0,09 Therefore, n ≥ 61 Data Analysis • SPSS 20.0 • Analysis of variance ANOVA, t-Test (p value<0,05) Research design • Prospective observation with analysis 10 1 RESULTS - DISCUSSION 5 Baseline Clinical Characteristics 0% 5% 10% 15% 20% 25% 30% 35% 40% 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 3.1% 16.9% 38.5% 36.9% 4.6% P A T IE N T R A T IO ( % ) AGE GROUP Age Mean : 46,63 ± 9,07 (22 - 63) Female (69%), Male (31%) 58.5% 9.2% 32.3% Mitral stenosis Mitral regurgitation Both • Concomitant procedure of MVR: tricuspid valve repair with autologous pericardium took majority (46,15%) • Valve size 27: 61,5% Post surgery: 2 years on average (24,71 ±11,63 months) Sinus rhythm (72%) Targeted INR 38%. 1 RESULTS - DISCUSSION 5 Baseline Clinical Characteristics Author (Year) n Post Surgery N.H.Hạnh (2005) 47 4-28 days N.Đ.Hiền (2007) 74 Early after L.T. Phát (2007) 131 6 months V.Q.Nga (2013) 80 12 months Lori A. Blauwet (2013) 368 < 30 days Our study 65 24 months 12 1 RESULTS - DISCUSSION 5 Structures and hemodynamic parameters of valve No. Hemodynamic parameters Mean ± SD Min - Max n 1 Vmax (m/s) 1,78 ± 0,3 1,03 - 2,51 64 2 Gmax (mmHg) 13,15 ± 4,18 5,65 - 25,10 63 3 Gmean (mmHg) 4,92 ± 1,72 2,34 - 10,90 64 4 PHT (ms) 85,39 ± 16,12 56,7 – 158,2 61 5 EOA(PHT) (cm 2) 2,65 ± 0,44 1,39 - 3,88 61 7 EOAI(PHT) 1,74 ± 0,36 0,99 - 2,75 61 8 PPI(PHT) 0,71 ± 0,14 0,45 - 1,07 61 9 CSDT(PHT) (%) 153,64 ± 14,91 129,12 - 208,53 61 10 EOA(CE) (cm 2) 1,78 ± 0,43 0,80 - 2,88 64 11 EOAI(CE) 1,16 ± 0,29 0,57 - 1,92 64 12 PPI(CE) 0,47 ± 0,12 0,26 - 0,82 64 13 CSDT(CE) (%) 154,47 ± 15,53 129,12 - 208,53 64 14 VTI Ratio 1,85 ± 0,49 0,95 - 3,34 64 1.16 1.82 1.91 2.18 1.78 - 0.50 1.00 1.50 2.00 2.50 3.00 N.H.Hạnh (2005) Bitar JN (1995) Joseph F. Malouf (2005) Lori A. Blauwet (2013) Chúng tôi EO A (C E) (c m 2 ) 1 RESULTS - DISCUSSION 5 Structures and hemodynamic parameters of valve PPM Frequency Percentage (%) n EOAI(PHT) ≤ 0,9 cm2/m2 0 0 61 EOAI(PTLT) ≤ 0,9 cm2/m2 12 18,75 64 EOA(CE) less than EOA(PHT) (p=0,00) 1 RESULTS - DISCUSSION 5 Structures and hemodynamic parameters of valve (PPM: Prosthesis-Patient mismatch) Author Vũ Quỳnh Nga, Nguyễn Hồng Hạnh: • LA improved evidently, mostly in mitral valve regurgitation cases. • LDd varied according to types of mitral valve disease. • PAPs reduced slightly. No. Basic echocardiograph y parameters Before surgery (1) Pre-surgery Early post surgery (2) At the point of observation (3) 1 LA (mm) Value 54,19 ± 12,33 44,94 ± 9,81 47,62 ±10,52 P p(2-1) = 0,00 p(3-2) = 0,01 p(3-1) = 0,00 2 LDd (mm) Value 46,24 ± 7,95 44,43 ± 6,42 43,34 ± 6,75 p p(2-1) = 0,05 p(3-2) = 0,17 p(3-1) = 0,00 3 PAPs (mmHg) Value 53,10 ± 18,79 33,58 ± 10,24 28,02 ± 6,2 P p(2-1) = 0,00 p(3-2) = 0,00 p(3-1) = 0,00 Explanation: Obstruction of blood flow through valve removed/No backflow from left ventricle of heart Recovery of pulmonary capillary bed after surgery 1 RESULTS - DISCUSSION 5 Compare the basic echo parameters between before and after valve replacement Conclusion 1: Baseline clinical characteristics of patients with Saint Jude valve CONCLUSION 6 1. Patients in middle age (46,63 ± 9,07), women (69%). Good BMI: 22,22 ± 2,98 2. Mitral stenosis: most of indication. Tricuspid valve repair with autologous pericardium (46,15%) 3. Valve size 27: mostly indicated. 38% of the patients had INR target Conclusion 2: Structure, hemodynamic of Saint Jude valve on Echocardiography CONCLUSION 6 2D • Two leaflets motion Doppler • Doppler waveform • Hemodynamic parameters of Saint Jude in mitral position Color Echo • Physiological regurgitation jets TT Hemodynamic parameters Mean ± SD 1 Gmean (mmHg) 4,92 ± 1,72 2 EOA(CE) (cm 2) 1,78 ± 0,43 3 EOAI(CE) 1,16 ± 0,29 Conclusion 3: Compare difference of basic echo parameters in periods CONCLUSION 6 1. Vmax, Gmax, Gmean decreased early post surgery 2. LA, Dd, PAPs significantly improved 3. Ds and EF unchanged RECOMMENDATIONS 7 Full observations on evaluation of prosthetic valve function. Calculation of EOAI to identify patients with prosthesis-patient mismatch Grouping patients: normal prosthesis function and prosthesis dysfunction
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