组织多普勒超声应用(2)

The complexity of right ventricular anatomy and geometry challenges accurate assessment of right ventricular systolic function, an important prognostic indicator in patients with heart failure and in postinfarction patients. Reduced tricuspid annular velocities with TDI have been documented in a variety of disease settings, including postinferior myocardial infarction, chronic pulmonary hypertension, and chronic heart failure.

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Cardiac Resynchronization Therapy (CRT)

Hsin-Yueh Liang MD

China Medical University Hospital

May 2007

Heart Failure with Dyssynchrony

Synchronization after CRT

Clinical Benefits of CRT

z 453 patients with moderate to severe HF

EF ≤35%, QRS ≥ 130 ms

z After 6 months

1. The distance walked in 6 min

2. Functional class

3. Quality of life

4. Time on the treadmill during exercise testing

5. Ejection fraction

6. Hospitalization

AHA/ACC guideline for CRT

Limitations of Wide QRS as Patient Selection Criteria for CRT z Non-responders of CRT are common: about 1/3 of patients

z LBBB vs IVCD vs RBBB: RBBB responders less favorable to CRT

(MIRACLE data)

z Patients with QRS of 120-150 ms respond less than with QRS> 150 ms Which Echo technique?

z M-mode

组织多普勒超声应用

z Pulsed-wave TDI

z Color-coded TDI

z TSI

z Strain

z 3 D

SPWMD M-mode

z 130 ms

Pulsed-wave TDI

z 60 ms

Color-coded TDI 2 segs

z 65 ms

Color-coded TDI 12 segs

z 100 ms

Tissue Synchronization Imaging

Strain

4D

Acknowledgment

z Theodore Abraham M.D, Johns Hopkins University, Baltimore, MD, USA z 周湘台 教授 中國附醫

z 李智雄 醫師 高醫附醫

z 林慶正 醫師 高醫附醫

z Anne Capriotti, Johns Hopkins University, Baltimore, MD, USA

z Roman Chojnowski, Johns Hopkins University Hospital, Baltimore, MD,

USA

组织多普勒超声应用

TEE Guide in the Deployment of ASD Occluder

Device

林維文

臺中榮民總醫院心臟血管中心

Atrial septal defect (ASD) is a common form of congenital heart disease accounting for approximately 10% of all congenital cardiac defects. It is caused by the failure of a part of the atrial septum to close completely during the development of the heart. ASD can be divided into several different types, including secundum, primum and sinus venosus type. Twenty percent of atrial septal defects will close spontaneously in the first year of life. One percent become symptomatic in the first year, with an associated 0.1% mortality. There is a 25% lifetime risk of mortality in unrepaired atrial septal defects. Certain types of ASD's (sinus venosus and primum varieties) have no chance of spontaneous closure, and patients with these types of ASD's are not candidates for transcatheter closure because of the location of the ASD. Open heart surgery is indicated for patients with these types of ASD's. Surgical closure of ASD has been practiced for more than 45 years, and has been considered the standard treatment for patients. Transcatheter closure of secundum ASD has evolved over the past three decades, and is being increasingly used in recent years. The Amplatzer septal occluder (ASO) is the most commonly used devices, due to it is safe and easy to use with a high success rate. Using echocardiography to carefully select certain subgroup of patient is important. It include secundum ASD (diameter less than 30 mm), a left-to-right shunt with a Qp/Qs ratio of .5:1 or the presence of right ventricular volume overload, the presence of a distance of greater than 5 mm from the margins of the ASD to the coronary sinus, atrioventricular valves and right upper pulmonary vein. Patient received anesthesia with transesophageal echocardiography (TEE) monitor was used in

组织多普勒超声应用

our early series. Intracardiac echocardiography (ICE) without generalized anesthesia is used in our patients. Live 3D transthoracic echocardiography (TTE), although does not need anesthesia, had several significant limitation, including low frame rate, poor spatial and temporal resolution. In our limited experience, transcatheter closure of secundum ASD using the ASO is a safe and effective alternative to surgical repair, with a good immediate results, but long term follow up is necessary. Appropriate patient selection is the most important factor for successful device closure.

组织多普勒超声应用

Clinical Application of Real-time 3D

Echocardiography

蔡惟全

Assistant Professor of Medicine

National Cheng Kung University Medical Center

The concept of 3D echocardiography is not new. Dynamic 3D cardiac image could be obtained from acquiring 2D imaging and reconstructed using an off-line process previously. Recently, 3D echocardiography can be acquired “live” by using a newly developed matrix array probe. However, clinical applications of real-time 3D echocardiography (RT3D ECHO) are not well established.

The potential advantages in clinical applications of RT3D ECHO include 1) better imaging and locating cardiac structure changes; 2) improved cardiac quantification; 3) providing therapeutic applications.

(1) Better imaging and locating cardiac structure changes: Using 2D echocardiography, it was difficult to locate the exact area of abnormalities. One of the immediate impacts of RT3D ECHO is that provides an accurate “surgical view” of the heart prior to surgery through the enhanced ability to identify and pinpoint the exact locations of abnormalities.

(2) Improved cardiac quantification: RT3D ECHO is a much better option than other imaging methods for left ventricular volume assessment as it enables clinicians to measure without making geometric assumptions.

(3) Providi …… 此处隐藏：3799字，全部文档内容请下载后查看。喜欢就下载吧 ……