JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Results
Discussion
Disclosures
Acknowledgements
Materials
References
Automatic Translation
Medicine

En forenklet trinvis tilgang til ekko vejledning under perkutan mitralklap reparation

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

Summary

Denne protokol præsenterer i detaljer, hvordan man udfører realtids ekkokardiografisk vejledning under transcatheter mitralventil reparation. De grundlæggende synspunkter og de nødvendige målinger er beskrevet for hvert trin i proceduren.

Abstract

Perkutan transkatheter kant-til-kant rekonstruktion af mitralklappen er en sikker og veletableret behandling for svær symptomatisk mitral regurgitation hos patienter med høj kirurgisk risiko. Ekkokardiografisk vejledning ud over fluoroskopi er guldstandarden og bør udføres ved hjælp af en standardiseret teknik.

Denne artikel indeholder vores reproducerbare trin for trin ekkokardiografisk vejledning, herunder synspunkter, målinger samt fremhæve eventuelle vanskeligheder, der kan opstå under proceduren.

Denne artikel indeholder detaljerede og kronologiske ekkokardigrafiske visninger for hvert trin i proceduren, især præferencer mellem 2D- og 3D-billeddannelse. Hvis det er nødvendigt, pulsbølge, kontinuerlig bølge og farve doppler målinger er beskrevet. Da der ikke er nogen officielle anbefalinger til kvantificering af mitral regurgitation under den perkutane kant-til-kant-reparationsprocedure, er der også medtaget rådgivning til ekkokardiografisk kvantificering efter at have taget fat i mitralbrochurer og efter indsættelse af enheder. Derudover omhandler artiklen vigtige ekkokardigrafiske synspunkter for at forebygge og håndtere mulige komplikationer under proceduren.

Ekkokardiografisk vejledning under reparation af transkateter mitralventiler er obligatorisk. En struktureret tilgang forbedrer samarbejdet mellem interventionist og imager og er uundværlig for en sikker og effektiv procedure.

Introduction

Mitral regurgitation (MR) er den næsthyppigste indikation for ventilkirurgi i Europa1. Ubehandlet, det kan føre til alvorlige hjertesvigt og nedsat livskvalitet2,3,4. Den perkutane mitralventil reparation (PMVR) er et kateter-baseret teknik, som efterligner Alfieri søm kirurgisk metode til mitral reparation ved at forbinde A2 og P2 kammuslinger5. For patienter med høj kirurgisk risiko tilbyder denne teknik en minimalt invasiv tilgang til behandling af alvorlige MR. Data fra flere registre og forsøg har vist, at MitraClip-proceduren, en transkateter mitralventilreparationsbehandling, er en effektiv og sikker metode6,7,8,9. I 2019 blev en lignende enhed, PASCAL transkateterventilreparationssystemet, introduceret på markedet. Det har vist gennemførlighed og acceptabel sikkerhed i behandlingen af patienter med svær MR10. PMVR’ens varighed og succes afhænger af den enkelte operatørs dygtighed og erfaring11. I modsætning til andre perkutane teknikker, som den perkutane transvalvlære udskiftning (TAVR), som kun kan udføres med fluoroskopi, kræver PMVR ekkokardiografisk vejledning12,13.

I denne artikel beskrives den ekkokardigrafiske tilgang trin for trin under PMVR, herunder målinger, forslag til intraprocedural kvantificering af MR og vigtige synspunkter for at forhindreperiprocedural komplikationer.

Protocol

Protokollen følger retningslinjerne fra vores institutions humane forskningsetiske komité. 1. Evaluering før intervention Udeluk perikardieafsmitte før transseptal punktering. Hvis en lille perikardiel effusion er til stede, måle den maksimale ende-diastolisk ekkolucent plads i en fire-kammer (4Ch) visning med fokus på højre ventrikel (RV), en mid-spiserør højre ventrikel indstrømning visning, og en lang akse (LAX) visning. Vurder det lungevenøse flowmønster med…

Representative Results

Perkutan kant-til-kant ventil reparation er et alternativ til kirurgisk ventil reparation eller udskiftning hos patienter, der ikke er berettiget til kirurgi med symptomatisk svær MR. Den første kliniske anvendelse af MitraClip blev undersøgt i Endovascular Valve Edge-to-Edge Repair Study I (EVEREST I)14-studiet. Mange andre forsøg har vist effektiviteten af proceduren med en forbedring af symptomerne samt lave hospitalsdødelighed og bivirkninger (ACCESS EU, TRAMI, EVEREST II)<sup class="xref…

Discussion

Ekkovejledning til PMVR er en sikker metode. Komplikationer på grund af ekkokardiografi kan forekomme, men sjældent føre til betydelig skade. Ikke desto mindre er esophageal læsioner mulige efter udførelse af transesophageal ekkokardiografi. Denne forekomst reduceres med en kortere varighed afinterventionen 34. Tværtimod beskrives flere komplikationer i forbindelse med transkateteret kant-til-kant mitralventilreparation35,36. Større…

Disclosures

The authors have nothing to disclose.

Acknowledgements

Vi takker Ms Dorothea Scheurlen for teknisk video support.

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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