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Year 3 Cardiac physiology > CC11: TAVI and Mitra -Clip > Flashcards

CC11: TAVI and Mitra -Clip Flashcards

(53 cards)

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1
Q

Causes of MR

A

-Rheumatic fever
-HCM/DCM
-Mitral valve prolapse
-MI
-Endocarditis

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2
Q

Symptoms of MR

A

-SOB (pulmonary oedema)
-Arrhythmias/palpitations
-Swollen ankles/feet

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3
Q

Types of MR

A

Degenerative
-Mitral valve itself is dysfunctional (e.g. prolapse)

Functional MR
-Issues outside of the valve cause leakage
-Most common is heart failure LV dilation causing dilation of the mitral annulus and tethering of leaflets

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4
Q

What does this image show?

A

-Valve prolapse
-Valve falls behind annular line and flails

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5
Q

How can MI cause MR?

A

-MI causes papillary muscle necrosis
-Chordae tendon snap

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6
Q

What is pulmonary vein flow reversal?

A

-Blood flows from LA into pulmonary vein

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7
Q

Intervention options for MR

A

Gold standard: surgical intervention
-Valve repair
-Valve replacement
However, patient can be at high surgical risk

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8
Q

Mitraclip procedure

A

-Access: Femoral vein, IVC, RA, puncture IAS, LA
-TOE performed to check LAA for clot, confirm device position and leaflet capture
-Perform gradient checks to confirm not causing stenosis

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9
Q

What does TOE confirm before clip is released?

A

-Clip position is good for reducing MR
-Clip is not causing mitral stenosis
-Ideally MV mean gradient <5mmHg

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10
Q

Does this echo show significant MR?

A

-Mean MV gradient <5
-Not significant MR

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11
Q

What does mitraclip leave behind?

A

-Iatrogenic ASD

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12
Q

What change do you look for in LA pressure after mitraclip?

A

-Reduction in V wave
-No significant increase in mean pressure

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13
Q

Describe features of Triclip?

A

-Femoral vein access
-Delivery system differs from mitral system as different angulation
-No need for septal puncture (right side)
-TOE guided

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14
Q

Complications of mitraclip

A

-Significant residual regurgitation
-Mitral stenosis (mean gradient > 5mmHg)
-Major vascular complication
-Cardiac perforation/tamponade

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15
Q

Causes of mitral stenosis

A

-Rheumatic fever
-Calcium deposits
-Radiation therapy
-Congenital

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16
Q

Symptoms of mitral stenosis

A

-SOB
-Fatigue
-Swollen legs/feet
-Palpitations
-Dizziness/fainting

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17
Q

What is the gold standard treatment for mitral stenosis?

A

Surgical valve replacement

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18
Q

Other methods of treating mitral valve

A

-Mitral valve balloon valvuloplasty
-Mitral valve replacement (TMVR)

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19
Q

What is the lampoon procedure?

A

-Cutting the mitral valve prior to TMVR
-This prevents LVOT obstruction

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20
Q

How to perform trancatheter tricuspid valve replacement (TTVR)?

A

-TOE and angio guided to confirm position
-TOE and RV gram to check for significant leak
-Usually for valve in valve procedures

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21
Q

Who is pulmonary valve replacement done on?

A

-Congenital patients

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22
Q

How does tricuspid valve replacement affect RV function?

Study These Flashcards
A

-RV contraction is mainly longitudinal (up and down)
-Tricuspid valve reduces longitudinal function
-Causes poor RV function

23
Q

What are the causes of aortic stenosis?

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A

-Calcium build up on valve
-Congenital
-Rheumatic fever

24
Q

Symptoms of aortic stenosis

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A

-Chest pain
-Dizziness
-SOB
-Fatigue
-Palpitations

25
Risk factors for aortic stenosis
-Older age -Congenital -Diabetes -High cholesterol -High blood pressure
26
Diagnosis of aortic stenosis
-Heart murmur -Cardiac cath -Imaging: Echo, MRI, CT
27
Treatment for aortic stenosis
-Surgical aortic valve replacement -Balloon valvuloplasty -TAVI
28
Factors to consider when choosing between surgical AVR and TAVI
-Patient's age -Patient's choice -Estimated surgical risk/co-morbidities -Clinical characteristics -Anatomical and technical aspects
29
What is the gold standard treatment for aortic stenosis?
-Surgical aortic valve replacement
30
How is surgical aortic valve replacement carried out?
-Patient on heart/lung bypass machine -Medical sternotomy -Stenotic valve removed and replaced with new valve
31
Why would surgical aortic valve replacement be chosen over TAVI?
-Poor TAVI access -Aortic dimensions unsuitable -Valve morphology unfavourable -Active or suspected endocarditis -Other surgical intervention required
32
What are the types of surgical valve?
Mechanical -Very durable -Needs lifelong anticoagulation due to increased risk of blood clots Tissue valve -Can be human or porcine -Less durable -Does not require anticoagulation
33
Why is balloon aortic vavuloplasty not used anymore?
-Prior to TAVI, BAV was the only alternative to surgical AVR -However, it poses a significant risk of AR -Now used as part of TAVI, pre or post valve
34
Why is pacing used in TAVI?
-Fast pacing required to lower blood pressure -This prevents valve being displaced by the LV/aortic pressure -Pacing normally >180bpm
35
Benefits of TAVI
-Less invasive -Shorter procedure time -Less/no intensive care time -Shortened recovery time/hospital stay -More rapid improvement in QoL
36
What is access for TAVI?
-Radial access for pigtail catheter for aortagram -Valve requires a large access => Transfemoral => Subclavian =>Transcaval
37
What is transcaval approach?
-Femoral vein into femoral artery
38
Pre TAVI procedures
Echocardiogram -Assess aortic valve, morphology, gradients, valve area, regurgitation -Assess for other valvular disease -Assess chamber size and function CT scan -Assess aortic valve diameter and area -Valve calcium score -Measure coronary height -Access entire course of aorta and femorals for access evaluation
39
How did TAVI valves develop
-New valves have skirts to prevent paravalvular leak
40
What should you do if you're trying to pace at 180 but not achieving?
-Check Safari wire position -Refractory time with blocked paced beats -Consider starting slow and ramping up
41
What should you do if you're pacing at 180bpm but not enough pressure drop?
-Pace faster -However, more risk of triggering VT/VF
42
Why do you do aortagram after valve is implanted?
-Check for paravalvular leak -Check coronaries are not blocked
43
What are self expanding valves?
Abbott Navitor -No need for rapid pacing -Gradual deployment - valve can be retracted -Large open cell geometry - minimises obstruction to coronary ostium -Reduces paravalvular leak
44
What is a complication of TAVI?
-Paravalvular leak
45
Causes of paravalvular leak?
-Native anatomy - calcification -Under-expanded valve - could balloon valve -Undersized valve -Valve malposition
46
How to identify paravalvular leak?
-Angiography -Intra-procedural TTE -Haemodynamics (AR)
47
TAVI vs surgical AVR risk
-No significant difference in death, stroke, MI TAVI higher risk of: -Major vascular complications -Paravalvular leaks -Need for permanent pacemaker Surgical AVR higher risk of: -Major bleeding -Tamponade -Increased risk of post-operative AF
48
Why is there a high pacing risk with aortic valve replacement?
-Aortic valve is near AV node/bundle branches
49
What is most common conduction abnormality in TAVI?
-LBBB -AV block -Self expanding valves more likely to cause conduction disturbances due to exerting higher pressures
50
Why would you not use temporary pacing wire for all patients?
-Creates hole that increases risk of cardiac tamponade and vascular complications -Use Safari guidewire instead unless patient is high risk (RBBB and AV block) -Patient's pacemaker can be used
51
Downsides of Safari pacing
-Wire is supporting the whole TAVI system, not stable, unreliable threshold -Pace at max output of temporary pacing box -If pacing dependent post-procedure, can't remove TAVI delivery system because pacing clip is on wire
52
What is the Jena valve for AR?
-Can be used on a non-calcific aortic valve -Therefore, can be used for AR -Clips to native leaflet to secure position
53
Why do echo pre and post TAVI?
-Check for effusion -Check for AR post TAVI -Anything unexpected (e.g. LV function, RV size, MR)

Year 3 Cardiac physiology (30 decks)

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