Vai trò của siêu âm tim 3d

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 2

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

- Case series report study

- Compare the diagnosis before and after

intervention or operation

3 D Echocardiography

Fully sampled Array Transducer

Matrix-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

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

Normal MV fr LA view

MS: 3D TTE

MS: 3D TTE

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

Mitral Regurgitation

Mitral Regurgitation

Mitral Regurgitation

Mitral Regurgitation

Mitral Regurgitation: 2 Jets

Graduation of MR: PISA

Method

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 Clip

Mitral Clip 2D

Mitral Clip 3D

Transcatheter Aortic Valve

Clip Core Valve

Clip Edwards

Edwards and CoreValve

STUDY AORTIC VALVE : LIVE

3D Echocardiography

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

Sinus venosus ASD

Sinus venosus ASD

SVC sinus venosus ASDSVC sinus venosus ASD 3D

Multiple ASD

Multiple ASD 2 DMultiple ASD 3DMultiple ASD 2D colorMultiple ASD 3D color

IVC sinus venosus ASD

Multiple ASD

LA 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

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