Case-of-the-Week

Case of the Week

Home->COTW
AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Case-of-the-Week Information

The Case-of-the-Week is a presentation of 8 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE

Case of the Month Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Periprosthetic Leak

Case#: 18

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes. You need more cme units to do this COTW for CME (not required). Purchase CME Credits

Presentation:
65 you WM S/P PTCA, CABG 8 years ago. He has a Hx of HTN, NIDDM, COPD, MI. He presents with SEMI and CP. Cath shows LVEF 55%, RCA 100%, RIMA -> RCA OK, LAD 70%, LIMA -> LAD 70%. Mild to Moderate MR.

What is your assessment of the mitral valve?
What is your assessment of the IntraopPostOp loops of the mitral valve?
Please discuss the outcomes of periprosthetic leak in the mitral valve position.

Loops:

Case Discussion/CME Questions

The echo shows A2 and A3 prolapse of the mitral valve with a LVEF 50-60%. The MR is eccentrically directed and is severe. Mild to moderate pulmonary regurgitation is also present. After the mitral valve replacement a leak is present in the anterolateral aspect of the mitral valve. The leak is mild and borders on moderate.

O'Rourke looked at small or trivial periprosthetic leak (PPL) in the aortic and mitral valve position and found an incidence of PPL of 22.6% for the mitral valve. As these patients were followed with TTE postoperatively, he found that the PPL resolved or remained unchanged in the vast majority of patients. Older age, smaller body size, degenerative valve disease, or the use of a bioprosthetic valve increased the risk of a PPL. 1 patient (0.9%) required reoperation for a PPL.

The natural history of small or trivial PPL in two other studies indicated that small or trivial PPL does not progress. Patients with small or trivial PPL had either no change or resolution of the PPL on followup.

When a PPL does occur it most likely is going to occur in the anterolateral or the posteromedial aspect of the mtiral valve annulus which may indicate that these areas are more techinically demanding areas of the mitral valve.

Please answer the following questions correctly to obtain your CME.

Web Links/References

Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography
Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up.
Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography.
Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study

Instution Info

User Info

CME Info

Help

User License

HIPAA

References

Calcs

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.