JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Résultats
Discussion
Divulgations
Acknowledgements
Materials
References
Traduction automatique
Médecine

Uma abordagem simplificada de stepwise para orientação de eco durante o reparo da válvula mitral percutânea

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

Summary

Este protocolo apresenta em detalhes como realizar orientação ecocardiográfica em tempo real durante o reparo da válvula mitral transcateter. As visões fundamentais e as medidas necessárias são descritas para cada etapa do procedimento.

Abstract

A reconstrução transcateter percatesa da válvula mitral é uma terapia segura e bem estabelecida para regurgitação mitral sintomática grave em pacientes com alto risco cirúrgico. A orientação ecocardiográfica, além da fluoroscopia, é o padrão-ouro e deve ser realizada utilizando uma técnica padronizada.

Este artigo apresenta nosso guia ecocardiográfico passo a passo reprodutível, incluindo pontos de vista, medidas, além de destacar possíveis dificuldades que possam surgir durante o procedimento.

Este artigo fornece visões ecocardiográficas detalhadas e cronológicas para cada etapa do procedimento, especialmente preferências entre imagens 2D e 3D. Se necessário, são descritas as medidas de onda de pulso, onda contínua e doppler de cor. Além disso, como não há recomendações oficiais para a quantificação da regurgitação mitral durante o procedimento percutâneo de reparação de borda a borda, também está incluído conselhos para quantificação ecocardiográfica após a apreensão dos folhetos mitral e após a implantação do dispositivo. Além disso, o artigo trata de importantes visões ecocardiográficas para prevenir e lidar com possíveis complicações durante o procedimento.

A orientação ecocardiográfica durante o reparo da válvula mitral transcateter é obrigatória. Uma abordagem estruturada melhora a colaboração entre intervencionista e imager e é indispensável para um procedimento seguro e eficaz.

Introduction

A regurgitação mitral (MR) é a segunda indicação mais frequente para cirurgia de válvula na Europa1. Não tratada, pode levar a insuficiência cardíaca grave e redução da qualidade de vida2,3,4. O reparo percutâneo da válvula mitral (PMVR) é uma técnica baseada em cateter, que imita o método cirúrgico de ponto Alfieri para reparar mitral conectando as vieiras A2 e P25. Para pacientes com alto risco cirúrgico, esta técnica oferece uma abordagem minimamente invasiva para o tratamento de RM grave. Dados de diversos registros e ensaios mostraram que o procedimento MitraClip, uma terapia de reparação da válvula mitral transcateter, é um método eficaz e seguro6,7,8,9. Em 2019, um dispositivo semelhante, o sistema de reparo de válvulas transcateter PASCAL, foi introduzido no mercado. Demonstrou viabilidade e segurança aceitável no tratamento de pacientes com MR10grave . A duração e o sucesso do PMVR dependem da habilidade e experiência do operador individual11. Ao contrário de outras técnicas percutâneas, como a substituição transvalvular percutânea (TAVR), que pode ser feita apenas com fluoroscopia, o PMVR requer orientação ecocardiográfica12,13.

Este artigo descreve passo a passo a abordagem ecocardiográfica durante o PMVR, incluindo medições, sugestões de quantificação intraprocedural do RM e pontos de vista importantes para prevenir complicações periprocais.

Protocol

O protocolo segue as diretrizes do comitê de ética em pesquisa humana da nossa instituição. 1. Avaliação antes da intervenção Exclua a derrame pericárdio antes da punção transsepcional. Se houver um pequeno derrame pericárdico, meça o espaço ecolúcido final-diastólico máximo em uma visão de quatro câmaras (4Ch) com foco no ventrículo direito (RV), uma visão de saída de saída ventricular direita do esôfago médio e uma visão de saída de fluxo de longo eixo (L…

Representative Results

O reparo percutâneo da válvula de borda a borda é uma alternativa ao reparo ou substituição da válvula cirúrgica em pacientes não elegíveis para cirurgia com ressonância magnética grave sintomática. A primeira aplicação clínica do MitraClip foi investigada no estudo de reparo endovascular edge-to-edge da válvula de borda a borda I (EVEREST I)14. Muitos outros estudos comprovaram a eficácia do procedimento com melhora dos sintomas, bem como baixas taxas de mortalidade hospitalar e …

Discussion

A orientação ecológica para o PMVR é um método seguro. Complicações devido à ecocardiografia podem ocorrer, mas raramente levam a danos significativos. No entanto, lesões esofágicas são possíveis após a realização da ecocardiografia transesofágica. Essa incidência é reduzida com menor duração da intervenção34. Pelo contrário, várias complicações associadas ao reparo da válvula mitral de borda a borda do transcateter são descritas35,<su…

Divulgations

The authors have nothing to disclose.

Acknowledgements

Agradecemos à Sra. Dorothea Scheurlen pelo suporte técnico em vídeo.

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
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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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