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Conclusions

Compared to MT alone and given conventional threshold values, MitraClip can be considered a cost-effective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other non-pharmaceutical strategies for heart failure.

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https://www.sciencedirect.com/science/article/pii/S016752731630211X?via%3Dihub

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Ontem fui procurado por uma representante do MitraClip no estado.

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Preço?

Algo como 180 mil reais

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Nos EUA são gastos 30 mil dólares ou 110 mil reais .

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Estão procurando ecocardiografistas de serviços de  alto volume.

Sabem que os casos para MitraClip passam por laboratórios de ecocardiografia.

Convidam a selecionar casos e enviar o vídeo para eles definirem a indicação de MitraClip.

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Já fizemos nossos questionamentos aqui:

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https://echotalkblog.com/2018/06/08/insuficiencia-mitral-como-causa-de-dispneia/

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https://www.sciencedirect.com/science/article/pii/S1936878X18301086?via%3Dihub

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Mitral Valve Regurgitation in the Contemporary Era: Insights Into Diagnosis, Management, and Future Directions

Author links open overlay panelAbdallahEl SabbaghMDYogesh N.V.ReddyMBBSRick A.NishimuraMD

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The optimal timing of intervention requires a comprehensive 2-dimensional and Doppler echocardiogram in each patient to determine the cause of the mitral valve disease, the severity of the regurgitation, and the effect of the volume overload on the left ventricle, as well as determining if a durable valve repair can be performed.

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O grande mestre da ecocardiografia escreve o artigo do ano sobre regurgitação Mitral.

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E melhor ainda, na escrita do mestre e não do blog:

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Críticas para todos os parâmetros isolados:

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Diagnóstico feito por nossa ecocardiografista Dra Daniela.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794462/

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When the blood flow contracts to pass through a stenotic orifice, a portion of the potential energy (ie, blood pressure) is converted into kinetic energy, thus resulting in a pressure drop and acceleration of flow (Figure 1) (19,20). Downstream of the vena contracta, the flow jet re-expands, which causes flow turbulences. As a result of these turbulences, a large part of the kinetic energy is irreversibly lost as heat. Nonetheless, a portion of the kinetic energy is reconverted back to potential energy (pressure). The extent of this pressure recovery essentially depends on the relationship between the size of the valve orifice and the size of the aorta (Figure 1) (19). The smaller the valve orifice relative to the size of the aorta, the more flow turbulence will occur and the less energy will be available to be recovered as pressure.

Doppler measurements rely on the maximum velocity or gradient measured across the aortic valve at the level of the vena contracta. On the other hand, catheterization measurements are generally performed a few centimeters downstream of the valve, where the pressure is fully recovered. As a result, the pressure gradient recorded by catheterization, which corresponds to the ‘recovered’ or net pressure gradient, tends to be lower than the Doppler gradient, especially in patients with smaller aortas (ie, aortic diameter at the sinotubular junction less than 30 mm). Consistently, catheter measurements will also yield larger values for EOA, compared with measurements derived from Doppler. In this context, it should be emphasized that the American College of Cardiology/American Heart Association guidelines were first established based on data obtained from catheter measurements (12). The same cut-point values (eg, EOA less than 1.0 cm² for severe AS) were then extended to echocardiographic data on the assumption that Doppler EOA and catheter EOA were equivalent parameters and indeed, the guidelines make no distinction between catheter and Doppler measurements of EOA. However, these parameters are not, in fact, equivalent, and differences in results of up to 50% may be observed depending on the size of the aorta and the severity of the stenosis

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Texto muito bom e explicativo das diferenças entre os gradientes obtidos ao CATETERISMO e ao ECOCARDIOGRAMA.

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A energia que ele afirma ser “perdida” na forma de calor, pode ser a responsável por dilatar a raiz da aorta?

Sendo assim, estenose grave só deveria ser encontrada em paciente com raiz da aorta dilatada.

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Então as dimensões da raiz da aorta deveriam entrar na avaliação da gravidade da estenose.

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Diferenças na velocidade e locais de alta velocidade em uma mesma prótese , a segunda têm uma capa que recobre a via de saída e promove uma medida de velocidade menor, supostamente, menos Mismatch.

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Mesma situação, analisando agora a pressão.

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