tee after repair: success or failure - uniklinikum · pdf fileme sax view, me lax view....
TRANSCRIPT
![Page 1: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/1.jpg)
12.09.2013
TEE after Repair:Success or Failure ?
Frank LangerDepartment of Thoracic & Cardiovascular Surgery
![Page 2: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/2.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Careful TEEassessmentrequired !!!
![Page 3: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/3.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Evaluation of Mechanisms
AV-morphology ?Cusp configuration ?Calcification ?
ME SAX view, ME LAX view
![Page 4: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/4.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Evaluation of Mechanisms
AV-diameterSinus diameterSTJ-diameterAA-diameter
ME LAX view
![Page 5: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/5.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Evaluation of Mechanism
ME LAX view, ME SAX view
Grade of AR ? (jet width, VC)Jet direction ? (eccentric vs. central)Jet origin ?
![Page 6: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/6.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Critical 6 stepsof assessmentrequired !!!
![Page 7: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/7.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 1
Immediately afterremoval of X-clamp:LV-distension ???
![Page 8: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/8.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 2
Immediately afterremoval of X-clamp:LV ejection without volume loading is suggestive of significant AR
![Page 9: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/9.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 3
Immediately afterremoval of X-clamp:Confirm AV-morphology (ME LAX)
![Page 10: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/10.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 4
Immediately afterremoval of X-clamp:Evaluate residual AR (ME LAX, SAX):
degree (VC < 4mm) ?residual prolapse ?
![Page 11: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/11.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 5
Weaning from CPB:Wide amplitude of arterial pressurewith low diastole suggests significant AR
![Page 12: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/12.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Residual Aortic Regurgitation
Step 6
Weaning from CPB:AR I: Accept !AR II: Comorbidities ? Alternatives ? EH ?
AR III, IV: Optimize ? Replace ?
![Page 13: TEE after Repair: Success or Failure - uniklinikum · PDF fileME SAX view, ME LAX view. Edwards Workshop 12.09.2013 Frank Langer: TEE after Repair: Success or Failure ... Frank Langer:](https://reader031.vdocuments.us/reader031/viewer/2022030404/5a79dbef7f8b9a9e0c8d9525/html5/thumbnails/13.jpg)
Edwards Workshop 12.09.2013
Frank Langer: TEE after Repair: Success or Failure
Conclusions
• Careful analysis of mechanisms is an essential step for successful repair.
• Standardized evaluation steps allow correct assessment of repair results.