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Therapy Assessment: Replacement - TVMR

This video shows how to appropriately size the transcatheter mitral valve.

For transcatheter mitral valve replacement, the key measurement is the mitral annular dimension and this allows us to. Size appropriately. Transcatheter mitral valves if the size of the mitral annulus is too large, they may not be a candidate for this therapy, so it's very important to measure this accurately, and in addition, there are a number of different sizes of transcatheter mitral valves and the appropriate size is measured this way in addition to. Cardiac computed tomography or CT. We can use 3D multi planar reconstruction to help us measure the mitral annulus. And you can see here on the right side we measure the anterior posterior diameter of the mitral valve and the Commerce are tekamah SharePoint. However, we can also use easy vals, which is a. Novel technology using machine learning based techniques to automatically measure the mitral annulus and this makes it a lot easier and potentially more reliable method for measuring the mitral annulus. And you can see here we are able to get these same exact measurement of AP diameter and Commerce order, sure or enter lateral to posterior medial diameter using easy valves. Also using Valves allows us to model the mitral valve dynamically, and in this case of functional mitral regurgitation. As you can see on the left, we can apply our model to the right. And superimpose the color. To demonstrate the location of Microsoft regurgitation as well as to measure various parameters, and in this case we're measuring the tenting height of the mitral valve along various points of the Coaptation line. Easy valves can also be used for other types of mitral graduation. In this case, this is degenerative mitral regurgitation on the left hand you see prolapse of the P2 scallop of the posterior leaflet with a flail segment. On the right side you see the model. Very nicely demonstrating the severe amount of prolapse in red, as well as capturing the flail segment.

Dynamic Esie valves: Degenerative MR (flail Dynamic Esie valves: Functional MR Diagnosis 11 11 6 16 Mtral Valve Frame 80 bpm / Ge 153/97 m Hg Ann AP 37.8 mm Multiplanar Lens Temp: 40.6• C Lens T : 40.rc Lens Ternp: C Lens T : 40.60 c Lens T Lens Tern Lens Tern : 401•c Ann AL-PM Diam 42.6 mm 4.5 12 vps vps dB 16 vps d 11 16 vps/ - 57.30 57.30 57 vps 59.2 mm 6 dB bpm bp Post Ann Perimeter 72.3 mm 106/ 6 16 reconstruction Antal Ann perimeter 131.5 mm Ann Area 1335.7 mm2 Dist 25.0 mm (MPR) Orifice Area 686.0 mm2 Intercomm Dist Intercommn Dist Intercomrn Dist 32.7 mm D58m.'s 058m,'s 038 nt.'s 068 nt.'s 058 m,'s 11 Hg Area 6860 rnrn2 6860 mrnm2 6860 rnmn2 6860 mnrn2 6 dB 58 I-PI Tenting'* Max Gap Max Flail Gap 17.2 mm 16.2 mm 19.9 mm 16.8 mm 131.5 mm 72.3 mm 32.7 mm 37.8 mm 9.8 mm 25.0 mm 6.5 mm 16.5 mm 6. mm mm A-i_pl Tenting Tenting Al _pl nting He • +l Tenting Height Al _pl nting He Al +1 Tenting A 1 _pl nting Height Tenting Height Al _p 1 nting Al-Pl Tenting Height Tentin Hg 13.2 mm 59.2 mm 12.2 mm 11.0 42.6 mm 14.5 10.7 12.1 92.6 8.9 9.8 9.6 94.6 rnrn -A2.P2 Tenting A2•P2 Tenting Hei æ•P2 Tenting A2•P2 A3•P3 Tenting ZP•2 nting Height A3•P3 A2.P2 A3-P3 Tenting •P2 Tenting +l-Pl Tenting Height• A•P2 Tenting Hei Tenting '+ight Tenting Tenti ng Height 59.2 mm 11.9 mm 15_8 131.5 mm 16.2 mm 16.5 mm 16_3 11_0 11.0 mm mm rnrn A2•P2 Tenting' Hg Height 16.5 14_4 72.3 mm 9.4 2 Distance 4.55 cm Distance cm Alan Vainrib, MD Instructor of Medicine NYU Langone Health, New York

  • Therapy Assessment: Replacement