Cardiac Ultrasound Technology and Mitral Valvuloplasty,HE Yihua, LI Zhian Beijing Anahen Hospital, Capital Medical University,Mitral apparatus：annulus、leaflets、chordae tendineae、papillary muscle Saddle shape of annulus，the highest point in the antero-posterior，the lowest point in the medial-lateral Carpentier anatomic description Three orders of chodae tendineae,Anatomy of MV,Echo features of RMS,Most common in the adult （99%） Thickened leaflets; adhesion of commissure; contraction of chordae tendineae Secondary calcification（most in the edge） Multiple leaflets involved,正常,Mitral valve thickening、calcification、restricted motion PML and AML: equidirectional motion; city wall changes Decreased EF-slope （non-specific finding） M-mode “A” peak wave disappeared Doming sign,Echo diagnostic key points of balloon mitral valvuloplasty,Severity of MS MVA5mmHg Severity of MR Combined valve disease or anomaly Mitral valve conditions Degree of mobility and calcification No commissure calcification No subvalvular chordal shortening At rest: SPAP50mmHg At stress: PGmean 15mmHgSPAP 60mmHg,Echo evaluation for MR,Etioloty Severity Location Secondary changes LV function,Echo key point for therapeutic determination,Etiology vs. therapeutic planning,Rheumatic,Ischemic,Mitral prolapse,Chordal rupture,Myxomatous degeneration,Valve replacement Excision of PML Chordal replacement Artificial chordae Edge to edge repair LV reconstruction Annuloplasty,Echo diagnosis for etiology of mitral diseases,Classification and Etiology,Normal Leaflet Motion,Restricted Leaflet Motion,Excess LeafletMotion,TYPE Normal Leaflet MotionNormal valvular motion Leaflet perforation or Cleft valve,TYPEExcess Leaflet MotionMyxomatous degenerationLack of fibrous frameworkChordal rupture,Chordal rupture,Chordal ruptrue Flail motion Eccentric regurgitation,Mitral prolapse,MVP : Eccentric regurgitation,Valve degeneration,PHVMD definition： Descripted firstly by Rippe et al in 1980 PathologiesMD in the fibrous layer DissolveRuptureMucopolysaccharideProtein accumulationNo calcificationNo severe fibrosis Predominantly involved mitra valve,Echo findingsValve Thickness Redundancy Floppy Billowing or ballooning ProlapseSecondary changes：Regurgitation, chordal rupture,Myxomatous degeneration,Combined valvular involvement,Thickening, floppy, redundancy of mitral valve,Evalve MitraClip,Deploy,Position and Grasp,TYPE Restricted Leaflet Motion(RLM),Coronary Sinus Reshaping,Coronary Sinus Annuloplasty,-Edwards Monarch-Cardiac DimensionsCarillon-Viacor PTMA*,Direct Annulus Plication,-Mitralign-Guided Delivery Systems,Posterior Annular Reshaping,Coronary Sinus- Atrial Reshaping,Left Ventricular Shape Change,-Myocor (Surgical/Perc),Trans-Atrial Shape Change,-Ample PS3 System,Device,Schematic,Mechanism,LV Antero- Posterior Reshaping,Current Percutaneous Technology for Functional MR,Implants consist of two epicardial pads connected by a flexible sub-valvular chord Surgical device=Intrapericardial device,Coapsys Implant,iCoapsys Implant,Myocor Transpericardial Mitral Repair,Myocor Transpericardial Mitral Repair,Courtesy of Wes Pederson, Abbott, Minneapolis, Minnesota.,Echo diagnosis for location of mitral diseases,Echo diagnosis for location of mitral diseases,TEE,TEE,Echo diagnosis for location of mitral diseases,TEE,Echo diagnosis for location of mitral diseases,3-Dimensional echo and intraoperative findings,Echo diagnosis for location of mitral diseases,Echo quantification for severity of mitral disease,Quantification of MR,Jet length: 、,Quantification of MR,PISA method,ERO = (2r2 x VPISA) / MR-Vmaxv,RV = ERO X MRTVI,Quantification of MR,Development of 3D Echo,Intraoperative location Study of annular function Study of ERO,Signification of studying annular morphology,Functional MR,Organic MR,Changes of annular morphology and function,Optimal surgical procedure,Current status of mitral annular study,Measurement variables,Height,Projection area,M-A ,Antero-posterior diameter,Longitudinal Displacement and velocity of annulus,IMR MVP,Annulus flattened、increased Antero-posterior diameter,穹隆体积增加,No obvious change of annular shape,Dynamic change of 3D-MVADuring a cardiac cycle,3D analysis of mitral valve,Coaptation area and index,Coaptation index,=,Surface area in early diastole Surface area in late systole,Surface area in early diastole,Coaptation area,Coaptation area and index,Coaptation area and index,Quantification of tenting volume,Intraoperative monitoring,Complications of annuloplasty,Residual MR Residual or new MS SAM or prosthetic strut protrusion with LVOT obstruction Left or right ventricular dysfunction Coronary occlusion from annuloplasty or valve ring suture Pseudoaneurysm formation at site of debridement of mitral annular calcification Shunts related endocarditis AR secondary to suture placement or annular distortion Embolism events,