Alsharqia riyadh echo meeting
This presentation is the property of its rightful owner.
Sponsored Links
1 / 90

Alsharqia.riyadh Echo meeting PowerPoint PPT Presentation


  • 108 Views
  • Uploaded on
  • Presentation posted in: General

Alsharqia.riyadh Echo meeting. Dammam KSA SAYED ABOU EL SOUD MD SBCC. Case 1. History. 48 y old Saudi lady Hypothyroidism,ch . Spondylisis H/O intracranial HTN 6 years before admission & ventriculoperitoneal shunt ( removed later )

Download Presentation

Alsharqia.riyadh Echo meeting

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Alsharqia.riyadh Echo meeting

Dammam KSA

SAYED ABOU EL SOUD MD

SBCC


Case 1


History

  • 48 y old Saudi lady

  • Hypothyroidism,ch. Spondylisis

  • H/O intracranial HTN 6 years before admission & ventriculoperitoneal shunt ( removed later )

  • Labarscopiccholecystecomy & RT modified mastectomy

  • Now neurologically grossly intact


  • S/P AVR in other hospital with tissue valve size 21 ( mosaic valve ) in 6/2011 ( 2 ys ago )

  • Presented to SBCC ( 2 month ago) with C/O chest pain , dyspnea and syncobal attacks

  • O/E obese well oriented pt

  • Ejection syst . murmer

  • ECG LV hypertrophy & strain

  • HB is 12.6 , creatinine 1.5


Preoperative TTE


PREOPERATIVE TEE


IMPRESSION

  • 48 y lady , obese , multiple co morbidities

  • Severely symptomatic relatively early postoperative

  • Significant :

    • gradient across AV & OFT

    • Severe LVH , normal LV function

    • Tilting partially supra- annular valve

    • leaflets opening well

    • Remnants of the native valve in 1st operation


  • GEOMETRIC ORIFICE AREA ( area blood flow through )

  • MOUNTING AREA (area occupied by the valve in the native annulus )


IMPLANT TECHNIQUE

  • TOATLLY INTRA ANNULAR : GOA/MOUNTING AREA = 40-70 %

  • PARTIAL SUPRA-ANNULAR : GOA/MOUNTING AREA= 80 %-85 %

  • TOTALLY SUPRAANNULAR : APPROACHES 100% MAXIMIZING BOOLD FLOW


Surgery

  • Aortic patch ( dilate aorta )

  • Valve replacement (tissue valve ) has Hx of intracranial HGE

  • Myomectomy ( dilate LVOT )


POSTOPERATIVE TEE


POSTOPERATIVE TTE


Case 2


History

  • 46 y old saudi female

  • K/C of HTN, hypothyroidism

  • K/C AVD, bicuspid AV with sever AS

  • S/P AVR “tissue valve”1 year ago


History

  • presented to our ER C/O

    • progressive exertional dyspnea up to NYHA III.

    • She also c/o of chest pain & near syncopal attacks

  • O/E

    • Pt had mild pulm. congestion & uncontrolled B/P 160/95

    • Ejection systolic murmur over the AV


TTE


TEE


Impression

  • Tissue valve opening well

  • Tilting valve

  • Significant gradient across aortic end of valve


Course

  • Discharged for second opinion

  • Lost follow up


Case 3


History

  • 18 yeas old saudi male.

  • s/p AVR “ metalic valve” & closure of VSD in another hospital

  • Pt presented to OPD completely asymptomatic.

  • Pt referred for echocardiography as baseline post operative echo.


TTE


TEE


Impression

  • Severely impaired LV function. ( normal preoperative )

  • tilting valve with Significant gradient across the aortic end . ( false moderate gradient due to LV dysfunction )

  • Fluoroscopy showed freely mobile leaflets with full range of movement


Course

  • very high risk for REDO surgery

  • Pt preferred to be referred back to the hospital where he performed 1st surgery


Arguments

  • Partially supra annular implantation to incraese GVA IS OPTIMAL ???

  • Why gradients not usually appear immediate postoperative and appear later in follow up???


Home message

Left for respected panel


  • Published data about Doppler hemodynamic parameters of normofunctioning prosthetic valves in aortic position


Baseline valve assessment

  • Therefore, the optimal timing of the baseline assessment of valve prosthesis haemodynamics should be placed between the third and the sixth month (not later than 1 year) after surgery.


  • . In patients undergoing aortic valve replacement, there is a relatively high output state immediately after the operation due to relative anaemia and sudden reduction of left ventricular afterload, which affects transprosthetic gradients. Moreover, perivalvularoedema and haematoma may reduce prosthetic EOA. Finally, left ventricular function will change significantly soon after aortic valve replacement due to regression of hypertrophy and adaptation to the changed pre- and afterload conditions


  • Login