 تو اینه اي که شکل در اگر این خطوة رو با گفته میگو اگر شما پروراو اول نلیر رو نه this one بخ Evriじゃない نموتب بخلان در اینه بخلان اینیم دنی ام وصد شویدو اینجوه باگار این اینجا می‌‌‌‌ظن بخلان اینی این این اینگا هه... از اف India نداریست ، چाیب حداو دوشان Hawman aren چحترام مالا بار کرده اگو که چ disclaimer سل needle حمايش از toma ها کهaws asuka م Ivany حمایش خیلیت زدیگا happens حال this is a case of a 44-year-old man presented to our center with severe mitral digitization due to mitral valve endocarditis and this case was done actually three four days ago by Yakovo in the war as you see this case is a so mitral valve is is distorted ام کالیسیم انگرینی قادر از سوری بای نگرند راک باین دوخار داوتیis چانی reveals a calisium in the vital analyst سو بیر امار امرک اینو نائی سری دی افتر وار رپلاسمن دیده گونات نگرین مکانی کال وار اینتی آنو تومیک، دیدی که اینو نید باینی نگرین که بای نگرین cigs شما بوصعی انسی ر overly هامسیم هام سے Fix Shell های م YunPP به تو ببuary اینی امیدی و حافیر اینم بطارباون شاید آرنگ و آ یورتوش. ه Wha و شاید خردو خرد دابی후 هmetaeوم ارسر قضان... سكر فیوق اگی میکنی میکنی فاور Anyways بهتر این باهد از نخوص ویرا. بگوی موما زیادة یا قراری طرح دادی آنوولار سرای دیگه با این مرزس بهوتکت ده گشارر کنکته امرو این قراری دارید وی ریدو ویلو لرانه حاوری، سردری برزای در این استیدار نشاند بیرگاها سرA این مخلوص ویرگ ویرگ ویرگ ویرگ ویرگ، ویرگ. بهتر این بسیر داری بار کنگه ویرگ، لکرurpی کارتی بارید با با اینتراد این کیا دا دیکی ذیرین با سبیار دخول اشترا تنب دیگه Instead, they followed about 608 patients for 2 year و پرون بسرMusic صور Meaning, from this 600,ARK 113 of them had a parvoval leak تی رایز دارو از ر gefunden you are not talking about more than mine تی رایز دارو از روسف From 113 patients that they had a small parvoval leak In the war detected by T Callan is one patient went to a serious deep in the future and they had to make a wrong replacement. So, only one. So, trays to mileage parv caveat-leak in the OR. Just leave it. Nothing will happen. OK. That's my first message. Second. What about the late Parva Voalik? The late parva大概 is a different story. So, the only parva volik in the OR is mainly technical problems. خلای کمادتهaman صرطkommen رفع، خلای خدا outro kendه하� tissue، خلای داره ان مسر gruppon prede بار試جب إitty ti supposed the calression the degree meant on and the events of the both or and the sha so they followed minorn s how do Do do do where do do Whether is sa that وار restraint. They followed them for six months. Out of these two thousand six hundred eighty, two hundred fifty-one of them, they had re-operation during this follow-up time. And that two hundred fifty-one, one hundred and fifty-one of them they had paravavalilik or theheissing of the valve. So late theheissing of the valve is about 0.5 percent of all mechanical valve replacement. های می اینجا دا تو کم طراب دور несوریمهم ز کن sufferang ..سنوی Report نهر را تا اینقوز Revolution و خاentoق خاentoق خا elbow با فرهوا به اصلات و را بت رو خوشد هم injuries خوشد خوشد نا با بوک于ان از سفرين ولدان آن نفت دیدیتی هاین به ایک تفحید زر باک ره و از سفر پوروار و از مجانه از خود بازدیتی باک ره باک باک ره باک باکی. هایے سفر آن نفت دیدیتی باک و از دفعید تن باک را اتنیی. حافت از از از خوب آلیها به از از خوب با بحوری زیاده از واقع يوندی کنی از از دووده از از خوب به از از موaring مواننم از خوب با بحوری زیاده که مواننے مواننی را از از مواننے را از از وکنه که وکنه از سیوهای مواننه از خوب آلیها بلا برای موواننی از مواننی را با بای را واقعم از دیگه khác و اوکتن داروزی باری روزی اینا قانی، اوکن شوینقین در مخفض روزی روزی روزی و نوتوری. برای یا کسی را بلکن معاک که آور است. اگه کل، دن لیگا، تو بایخان واسته بایخان بودی دیگه بندنی در مباشک به دیگه بودی، بایخان بودی مصايددیم بایخان بودی. حالا، ایکزم روزی آئیم که بودی splashingگو کند، بایخان دادی استoundsی بودیم بودی. و شما ایم Which is again one of the very old 3D of my center my previous center in Saudi Arabia and we saw all four valve together You see the eortic valve, tri gastroids valve, and myto valve This myto valve is this the orthic as well So we can develop the same cut that we had it in our model by the 3D How will allors place of the recommendation of paravolik could have to create from common language with our surgeon because we are dealing more always our interventionists in the cut live so first of all we develop this map as I was saying vary very tipping and then we have to create a map four other vall réussi جوشتستیOM مات نفشب م each work with no problem but anyway for localization و این مشکله واقعی توagedش بالمکرایسمه خوقت اطلاح47 مرسارش اطلاح از ندرز موجانه از هرشانه borders مجانه گ ان در جان بجانده برتا را در در از در از درức اکتر مجانه در تاتند ، در از در از در در در از درد است پеромانه، در موجانه گدر را در جاند ، در ميه نروذ از در نروذ پريفانه را از در از در سرگی به که مجانه و خطوط در از در مجانه گنید. This is the surgical view of all of the valve. Again this morning when we were talking about that we have to create the surgical view of the valve. we have it for mitral valve for a long time but for other valve we have to develop it. So this is surgical view. This is one of again one of our case so this is surgical view of the mitral valve on fast view up and down there is always on your left side, surgeon is standing here. Eortic valve is here. درهاب اکسان کردده. دوهای که اکسان که وقتی اکسان کردد دوهای که اکسان که خودد وقتی من اکسان کرددد. خودد وقتیم خودد وقتیم قاعدده. اhewsون آسی طاقیخه اکسان کهackeray هم ندنبر برای آج. بره اکسان بره به دل بای خودد وقتیم خوددت. than the view for aortic valve and for prosthetic aortic valve also, this is surgical view of the tricuspid valve, so in surgical view of the tricuspid valve again we have couple of landmarks first of all the sceptical reflet is beside the surgeon that s the reason that Professor Edward was talking this morning this reflet this sceptical reflet should be beside the surgeon surgeon is standing here. مع executive view the land morg for the for the walk forward the i put i am anقد نیا سرب کcheerful الح понад only to could to well mana انج ellisanna so alway the have to have a land or when we are showing something is really at your could talking this morning as well any song you Indiana show in seredy you have to have some land molt ایک افترام کننست فکر بان موضوع آن میکه صرشکه و روay as a kind of anatom بای، فکر فکر را میکن کن شاده فکر معانی احتوار تا سید را میکن انکان است هنی تترامتیider همشد ب CF و این میکنم شاده بشد اها انکن واقع درکن امکن را میکنم شاده باشر از آن اینradoب ... because we are showing to mainly for replacement امکن میکنم شاده باشر امکن اوکن نشان امکن و درکن و تو نو این هتب براند نرانی کارید و اینه اشکر انساند بارا إینی کارید ام برای امرو اپنی یارید و ادنیشت شد رو هیدی و درکنو کارید تا از نفط پر کسید lips ده اما براند کارید روید امرو بایonymousید مطر و علب و واقعی کارید و در این من فرم آتی بارید نو ادا باییک از سلیدی از سلیدی ام چه چیز آتی بارید And as you see that this is an hour 17 2009 wasn't very good but we were learning so we didn't have all of this facility that you have here which I learn and in my middle-east ourselves so this is the smallerlastity of the valve here next to the aorta and we gave this address to our interventionist you see the expert even the size of d兩個 and our interventionist went من آیورت Ta because this was closer to the airtime we see it and you see the previous picture just is the top is just beside three OK so if he goes he or she goes from the order can come here easily from the order to the forgiven so I went there and he put the plaque This is a like a P de devise and he closed it so it is very important to give the right address خیلی is a 68-year-old man underwent bioprostic MVR in our center 3 years ago. His MVR was implanted as top hat. Top hat is any time you have a lots of calcium in the mitral annulus, surgeon will put a valve at the top of that calcium, you got a top hat. So this patient developed paravavra leak as you see here. You see the bioprostic valve is in the LA site and leak is here. It looks a small leak but it's bigger than this. You will see it more now. Very severe, you see. Sweep the picture. Then 3D. So we showed it nicely in 3D. See the valve is the heist from here to here. Here is the terracott speed valve, here is the aortic valve. The entire anterior part of the valve is the heist. So surgeon said he is already 2nd set we do. I cannot take it. And we asked our intervention is to close it. To close you have to give them a guide in the cat lab. So surgeon decided to close this big gap. Also was very difficult by a device that we call it ampalazer paravavra leak device. Is approved in Middle East in Europe. I think in FDA is approved as well. Anyway, that's a leak. We see the leak in different angle. So we discussed the case in heart team and we decided to go by a device. So we close that leak with this device. This is a rectangular shaped PLD device. And you see important part is this device has to cross from RA to LA. So we have to guide the interventionist. It's not like a micro clip because this is more anterior. So again as Jacob was talking, explain is very important here. To see that you are going inside the LA, you are not going outside of the art. And this is okay. The cat is in wrong place at first. And then we told them and the next time they attended, they went in the right place. And they put this device also not perfect result, but it is less. So we accept it. Case number four is a 47 year old female with a story of MVR and TV repair. 16 years ago presented to our center with severe shortness of breath. See again this case has a severe paravavra leak from two side. Again we have to tell them from where is coming. You see the valve is not very clean because it is a valve of 16 years ago. If this valve was new when you do 3D you see all the sutures as well. But this valve is old. So again we have to give address to interventionist or surgeon to fix it. Here you see it. You see big leak is here beside the aorta and another very big leak beside the appendage. So interventionist said I cannot close it by the device. And surgeon said I will take it to the OR but I will reassure it. I will not replace it because again it is the second set we do. I will reassure it based on your address. So the best way to give the address is 3D. You say one big leak is at around 2 o'clock and one very big is around 9 o'clock for example. So surgeon went there and based on that address or map that we gave them. He closed it. He is in Cleveland now. So he closed it based on that address. And you see no leak at all. So that's the beauty of the 3D. You can give exactly. I remember when I was going to OR sometimes they were putting the device and say there's no hole. I could say it's just that place by my finger. Go and close it. Case number 5, 18-year-old boy was in the caraditis. Had mitral valve repair and very nice result after the repair. One year later came with shortness of breath. Severe more. So what's the problem? You will see it. It's no valve here. Had valve repair. No prosthetic valve. Here you see it. Something is here at the middle of the mitral valve. Big dehiscence. You see this is the ring. And ring moved entirely towards the aorta. So it's a posterior dehiscence of the annulus. Annular ring. And usually happens most of the time in posterior aspect of the ring. If you want to have a dehiscence. So big MR is coming from there. Again we discussed it. Our intervention said I can go and close the valve by mitral clip. You don't have to close that hole. Just close it by mitral clip you will decrease the MR. And at the end we decided to go to the OR. And take the ring out. I just want to show you how it looks like at the histrink. You see this is a posterior. It's exactly the place that we showed by 3D. From here to here. From posterior. This is a surgical aspect. And he repaired this valve. So this is the last case. 55-year-old man with the history of mechanical AVR one year ago. This is from here. We had a couple of days ago. This is a mechanical aortic valve. So I showed more mitral. Because I told you it's more common in mitral, parvavar leak. So this is a parvavar leak from mechanical aortic valve. I don't have 3D of this. So you can see it. This parvavar leak from here. You can see it from here. And this valve was replaced by a bioprostrict valve. So in summary, trivial or mild parvavar leak is the common finding in war. The clinical outcome and natural history of trace to mild parvavar leak is benign in majority of the case. And we don't have to worry about that. Late parvavar leak due to the essence of the valves is the most common indication for operation in long-term follow-up of the patient with mechanical valve. So it's the most common cause for re-operation in a long-term follow-up of mechanical valve. And the check-imaging technique, especially CDTE, plays an essential role in the diagnosis, a special orientation of the leak, guidance of the surgical or percutonus intervention, and evaluation of the outcomes. Thank you very much.