how to mitral breakout: mitral imaging i echo basics thursday, … · 2017-07-14 · how to mitral...
TRANSCRIPT
![Page 1: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/1.jpg)
How to Mitral Breakout: Mitral Imaging I – Echo BasicsThursday, June 04, 2015
8:30 AM - 10:00 AM Room: Williford C, Third Floor
James Hermiller, MD, FACC, FSCAI
St Vincent Medical Group
St Vincent Hospital, Indianapolis IN
Secondary Mitral Regurgitation: How Should We Treat?
(Case Presentation)
![Page 2: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/2.jpg)
How to Mitral Breakout: Mitral Imaging I – Echo BasicsThursday, June 04, 2015
8:30 AM - 10:00 AM Room: Williford C, Third Floor
James Hermiller, MD, FACC, FSCAI
St Vincent Medical Group
St Vincent Hospital, Indianapolis IN
Secondary Mitral Regurgitation: How Should We Treat?
(Case Presentation)
![Page 3: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/3.jpg)
Disclosure Statement of Financial Interest
• Consulting Fees/Honoraria• Speaker Bureau
• Medtronic, Edwards, Abbott, BSC, and St Jude
• AstraZeneca
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
James Hermiller,MDAffiliation/Financial Relationship Company
![Page 4: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/4.jpg)
History
• 84 year old man s/p prior MI, CABG, ICD, small CVA, presented in 2010 with 4+ functional MR
• Enrolled in REALISM study over 3 years ago
• Two Mitraclips placed with MR post procedure being trivial and follow up MR 1+
![Page 5: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/5.jpg)
History• Over 6 months he developed progressive CHF
• Optimal medical therapy – QRS duration
110ms
• Echo/TEE 4+ severe MR
• Clips well positioned with MR lateral to the two mitraclips
• EF 20%/low output/Creatinine – 2.2 mg/dl
• Lives independently, married, and had been active until the last several months
![Page 6: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/6.jpg)
ERO PISA - 0.62cm2RF – 53%RV 65cc
![Page 7: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/7.jpg)
![Page 8: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/8.jpg)
![Page 9: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/9.jpg)
Plan
• Prohibitive risk for surgery/VAD
• Medical therapy – hospice vs 3rd clip
• Planned 3rd clip
• Strategy– Transseptal mid fossa and not too posterior
– Large valve area – low risk of stenosis
![Page 10: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/10.jpg)
![Page 11: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/11.jpg)
![Page 12: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/12.jpg)
![Page 13: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/13.jpg)
![Page 14: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/14.jpg)
![Page 15: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/15.jpg)
![Page 16: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/16.jpg)
![Page 17: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/17.jpg)
![Page 18: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/18.jpg)
![Page 19: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/19.jpg)
![Page 20: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/20.jpg)
![Page 21: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/21.jpg)
![Page 22: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/22.jpg)
Follow Up
• 1+ MR – Device time 40 min
• Home the following day
• Renal function – post procedure
Cr fell to 1.6 mg/dl
• 6 months – FC II – No readmissions
![Page 23: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/23.jpg)
6 moth F/U
![Page 24: How to Mitral Breakout: Mitral Imaging I Echo Basics Thursday, … · 2017-07-14 · How to Mitral Breakout: Mitral Imaging I –Echo Basics Thursday, June 04, 2015 8:30 AM - 10:00](https://reader034.vdocuments.site/reader034/viewer/2022042412/5f2c1544ac117f2b566734d1/html5/thumbnails/24.jpg)
Thanks for your attention!