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Summary
Abstract
Introduction
Protocol
Résultats
Discussion
Divulgations
Acknowledgements
Materials
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Médecine

Un approccio graduale semplificato alla guida dell'eco durante la riparazione della valvola mitrale percutanea

Published: October 16, 2021
doi:
10.3791/62053
, , , ,
1Department of Internal Medicine/Cardiology,BG Klinikum Unfallkrankenhaus Berlin

Summary

Questo protocollo presenta in dettaglio come eseguire la guida ecocardiografica in tempo reale durante la riparazione della valvola mitrale transcatetere. Le viste fondamentali e le misurazioni necessarie sono descritte per ogni fase della procedura.

Abstract

La ricostruzione percutanea transcatetere edge-to-edge della valvola mitrale è una terapia sicura e consolidata per il rigurgito mitrale sintomatico grave in pazienti ad alto rischio chirurgico. La guida ecocardiografica oltre alla fluoroscopia è il gold standard e dovrebbe essere eseguita utilizzando una tecnica standardizzata.

Questo articolo espone la nostra guida ecocardiografica riproducibile passo dopo passo che include viste, misurazioni e mette in evidenza le possibili difficoltà che possono sorgere durante la procedura.

Questo articolo fornisce viste ecocardiografiche dettagliate e cronologiche per ogni fase della procedura, in particolare le preferenze tra l’imaging 2D e 3D. Se necessario, vengono descritte le misurazioni dell’onda a impulsi, dell’onda continua e del color doppler. Inoltre, poiché non esistono raccomandazioni ufficiali per la quantificazione del rigurgito mitrale durante la procedura percutanea di riparazione da bordo a bordo, sono inclusi anche consigli per la quantificazione ecocardiografica dopo aver afferrato i foglietti mitrali e dopo l’implementazione del dispositivo. Inoltre, l’articolo si occupa di importanti viste ecocardiografiche per prevenire e affrontare possibili complicazioni durante la procedura.

La guida ecocardiografica durante la riparazione della valvola mitrale transcatetere è obbligatoria. Un approccio strutturato migliora la collaborazione tra interventista e imager ed è indispensabile per una procedura sicura ed efficace.

Introduction

Il rigurgito mitrale (MR) è la seconda indicazione più frequente per la chirurgia valvolare in Europa1. Non trattata, può portare a grave insufficienza cardiaca e ridotta qualità della vita2,3,4. La riparazione percutanea della valvola mitrale (PMVR) è una tecnica basata sul catetere, che imita il metodo chirurgico del punto Alfieri alla riparazione mitrale collegando le capesante A2 e P25. Per i pazienti ad alto rischio chirurgico, questa tecnica offre un approccio minimamente invasivo per il trattamento della MR grave. I dati di diversi registri e studi hanno dimostrato che la procedura MitraClip, una terapia di riparazione della valvola mitrale transcatetere, è un metodo efficace e sicuro6,7,8,9. Nel 2019 è stato introdotto sul mercato un dispositivo simile, il sistema di riparazione delle valvole transcatetere PASCAL. Ha dimostrato fattibilità e sicurezza accettabile nel trattamento di pazienti con MR10grave . La durata e il successo del PMVR dipendono dall’abilità e dall’esperienza del singolo operatore11. A differenza di altre tecniche percutanee, come la sostituzione transvalvolare percutanea (TAVR), che può essere eseguita solo con fluoroscopia, pmvr richiede una guida ecocardiografica12,13.

Questo articolo descrive passo dopo passo l’approccio ecocardiografico durante la PMVR, comprese le misurazioni, i suggerimenti per la quantificazione intraprocedurale della MR e importanti viste per prevenire le complicanze periprocedurali.

Protocol

Il protocollo segue le linee guida del comitato etico per la ricerca umana della nostra istituzione. 1. Valutazione prima dell’intervento Escludere il versamento pericardico prima della puntura transsettale. Se è presente un piccolo versamento pericardico, misurare lo spazio echilucido finale-diastolico massimo in una vista a quattro camere (4Ch) con un focus sul ventricolo destro (RV), una vista di afflusso-deflusso ventricolare destro medio-esofageo e una vista ad asse lungo (LAX)…

Representative Results

La riparazione percutanea della valvola da bordo a bordo è un’alternativa alla riparazione o alla sostituzione chirurgica della valvola in pazienti non idonei per l’intervento chirurgico con MR grave sintomatica. La prima applicazione clinica del MitraClip è stata studiata nello studio Endovascular Valve Edge-to-Edge Repair Study I (EVEREST I)14. Molti altri studi hanno dimostrato l’efficacia della procedura con un miglioramento dei sintomi e bassi tassi di mortalità ospedaliera ed eventi avver…

Discussion

L’eco-guida per il PMVR è un metodo sicuro. Possono verificarsi complicazioni dovute all’ecocardiografia, ma raramente portano a danni significativi. Tuttavia, le lesioni esofagee sono possibili dopo aver eseguito l’ecocardiografia transesofagea. Questa incidenza si riduce con una durata più breve dell’intervento34. Al contrario, diverse complicazioni associate alla riparazione della valvola mitrale transcatetere bordo-bordo sono descritte35,3…

Divulgations

The authors have nothing to disclose.

Acknowledgements

Ringraziamo la signora Dorothea Scheurlen per il supporto tecnico video.

Materials

EPIQ 7 Ultrasound System Philips US218B0542 Cardiac Ultrasound Machine
X8-2t xMATRIX 3D-TEE probe Philips B34YYK TEE-probe
Sheath 6F 25 cm Merit Medical B60N25AQ Sheath
Dilator 16 F Abbott 405544 Dilator
BRK-1 transseptal needle 71 cm St. Jude Medical ABVA407201 Transseptal Needle
Swartz Lamp 90° St. Jude Medical 407356 Transseptal Guiding Introducer Sheath
Amplatz super stiff Kook Medical 46509 Wire
Steerable Guide Catheter Abbott SGC0302 Steerable Guide Catheter
MitraClip NTR Delivery System Abbott CDS0602-NTR Clip Delivery System
MitraClip NTR Bundle Abbott MSK0602-NTR Device
DOWNLOAD MATERIALS LIST

References

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Tags

Echo GuidancePercutaneous Mitral Valve RepairEchocardiographic ViewsTransseptal PuncturePericardial EffusionMitral Valve Assessment3D EchocardiographyColor DopplerMitral RegurgitationInterventional Echocardiography
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Gatti, A., Krieger, K., Seidel, M., Röttgen, A., Bruch, L. A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair. J. Vis. Exp. (176), e62053, doi:10.3791/62053 (2021).
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