Ecocardiografia en la sala de hemodinamia (Cierre CIA, Mitraclip, cierre orejuela izquierda); Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 02 Diciembre 2019; CDMX; IMSS CMN SS XXI Hospital de Cardiologia

1. Instituto Mexicano del Seguro Social
Centro Médico Nacional Siglo XXI
Hospital de Cardiología
Servicio de Ecocardiografía CMN Siglo XXI
“Ecocardiografía en la sala de Hemodinamia”
Dr. Ricardo Mora Moreno (MAECO)
Ciudad de México
02/ Diciembre / 2019

2. Objetivos
 Punción trans-septal.
 Mitraclip
 Cierre de orejuela izquierda

3. Punción Trans-septal

4. Guía Punción Trans-septal
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014
 Vistas eco cardiográficas ETE
 Esófago-medio: Vista eje corto válvula aortica (30º-60º)
 Orientación Antero-Posterior
 Esófago-medio: Vista bicaval (80º-110º)
 Orientación Infero-Superior

5. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

6. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

7. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

8. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014
Distancia:
Funcional: 35-40 mm
Degenerativa: 40-50 mm

9. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

10. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

11. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

12. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

13. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

14. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

17. Mitraclip

18. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

19. N Engl J Med 2011;364:1395-406.

20. N Engl J Med 2011;364:1395-406.

21. N Engl J Med 2011;364:1395-406.

22. N Engl J Med 2011;364:1395-406.

23. N Engl J Med 2011;364:1395-406.

24. N Engl J Med 2011;364:1395-406.

25. N Engl J Med 2011;364:1395-406.

26. Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

27. Contraindicaciones Mitraclip
N Engl J Med 2011;364:1395-406.
 Paciente quienes no toleren terapia anticoagulante durante o régimen de
terapia anti-plaquetaria posterior procedimiento
 Endocarditis activa
 Enfermedad valvular mitral reumática
 Evidencia de trombo venoso femoral, vena cava inferior o intracardiaco

29. Avance del dispositivo
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

30. Valorar dispositivo
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

31. Avance dispositivo hasta pared lateral
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

32. Valorar movilidad dispositivo y probar
los brazos
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

33. Alineación del dispositivo con plano
valvular
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

34. Alineación e introducción hacia
valvular mitral
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

35. Apertura de los brazos
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

36. Posicionamiento ortogonal del
dispositivo
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

37. Sujeción de las valvas
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

38. Valorar insuficiencia residual
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

39. Valorar captura de valvas en 2D y 3D
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

40. Valorar posicionamiento
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

41. Valorar posición e insuficiencia residual
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

42. Liberación sistema de entrega
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

43. Colocación de 2º dispositivo
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014
40-50% de los casos,
no es suficiente un
clip

44. Valorar área residual e insuficiencia
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

45. Valorar área residual e insuficiencia
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

46. Retiro de catéter guía
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

47. Valorar Complicaciones
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014
 Insuficiencia mitral residual
 Estenosis mitral
 Perforación
 CIA
 Rotura de cuerdas o valvas

48. Valorar Complicaciones
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014
 Insuficiencia mitral residual
 Estenosis mitral
 Perforación
 CIA
 Rotura de cuerdas o valvas

49. Valorar defecto septal iatrogeno
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

50. Cierre de orejuela izquierda

52. Anatomía OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

53. Relaciones OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

54. Determinar anatomía de OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

55. Barrido secuencial de OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

56. Mediciones de OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

57. Mediciones de OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

58. Detección de trombo en OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

59. Detección de trombo en OI
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

60. Elección dispositivo
Watchman
OI forma regular y
adecuada profundidad
comparada con el tamaño
del orificio
Amplatzer Cardiac Plug
OI con orificio grande y
pliegues entre los lóbulos
que protruyen hacia la
cavidad principal

61. Dispositivos
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

62. Dispositivos
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

63. Guiar punción trans-septal
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

64. Introducir catéter guía
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

65. Introducir catéter guía
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

66. Apertura del dispositivo
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

67. Liberación sistema de entrega
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

68. Vigilar presencia de trombos
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

69. Control y seguimiento posterior
Francesco Fulvio Faletra, Gila Perk, Natesa G. Pandian, Hans-Joachim Nesser, Itzhak Kronzon; Real-Time 3D Interventional
Echocardiography; Springer; 2014

70. Gracias!
Me dijiste que ya
habías terminado
Ecocardiografía