Mean MV gradient 13mmHg! Not tachycardic, well aligned CW Doppler
Admission with fluid overload
Very high gradient across 11yr old bioprosthesis
Could be SVD...so local hospital proceeds to TOE. Here are their 2D images
120degree view
One leaflet clearly fixed in this view, other leaflet moves well
Still a lot of turbulence on colour Doppler imaging
TOE MV mean gradient still high, above 10mmHg...
So, I'm sent images and asked what do I think. Patient stable & euvolaemic. Valve doesn't seem severely stenotic on 2D images (1 leaflet seems fixed). I wasn't convinced he needed urgent re-do surgery, but surgeons accepted transfer to our centre for more tests
So, we decide to repeat the TOE, this time with 3D imaging
Well, the surgeons decided to go back to theatre and replace the valve
As 3D TOE revealed, they found 2 leaflets were fused together & fixed, whilst 1 leaflet moved freely
Patient opted for another bioprosthesis
Here is the post-op echocardiogram - mean MV gradient down to ~4mmHg!
I think it's a great reminder of the utility of 3D echocardiography especially for assessing prosthetic valves - the 2D images here didn't suggest that valve alone should cause MVG of >10mmHg
Probably the most famous WB is Stephen Bolsin, the cardiac anaesthetist that was highly concerned by very high mortality rates in paediatric ❤ surgery in Bristol in late 1980s / early 1990s
He had to leave his job & could not find another job in 🇬🇧
First talk from Prof Takkenberg, who needs no introduction to any of you. A very important talk in which she questioned the primacy of RCTs and spoke up on the importance of 'real world' registry data, often dismissed as poor quality
If someone has already lived far past the average life expectancy in their country and is now into their 90s, can we *promise* the patient that TAVI will make them live longer?
In our centre, we feel that patients >90 need to be very motivated to have a procedure
This is a 🧵all about Transcatheter Mitral Valve Implantation (TMVI). If you don't know a lot about this and want to learn more - read on! This is a summary of a great expert focus session
First talk from Dr Gry Dahle (Oslo), on why TMVI is not the same as TAVI
TAVI has revolutionised treatment of aortic stenosis; TMVI is further behind largely due to anaromical complexity of treating the MV compared to the AV - the AV valves are much more complex than the semilunar valves!
Abstract session on Hot Topics in Transcatheter Therapies
Presentation from Dr Justin Robinson on use of TAVI in patients with very large aortic annuli - Results from the Michigan TAVI Quality Collaborative
#EACTS2021
Methods here: just over 200 patients with aortic annuli in excess of the normal ranges for both the Edwards Sapien and Medtronic Corevalve systems