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Valvular Hemodynamics

Valvular Hemodynamics. Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief Cardiology University California Irvine Orange, California. Hemodynamic Problems for the Cath Lab. Valvular heart disease: Aortic stenosis/insufficiency Mitral stenosis/insufficiency

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Valvular Hemodynamics

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  1. Valvular Hemodynamics Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief Cardiology University California Irvine Orange, California

  2. Hemodynamic Problems for the Cath Lab • Valvular heart disease: • Aortic stenosis/insufficiency • Mitral stenosis/insufficiency • Intraventricular gradients • Pericardial effusion/tamponade • Constrictive/restrictive physiology • Coronary Hemodynamics • Intracardiac Shunts

  3. Pa/Ao valves close Pa/Ao valves open Pa/Ao valves are closed systole Tri/MV valves open Tri/MV valves close Tri/MV valves open =Valve action

  4. BAMC Case #3117: Patient: 61 yo male Dx: 3V CAD filter: 50 Hz/ sample 250 Hz Normal LV and Aortic Pressure Fluid-filled system micromanometer transducers Fluid filled, FA sheath Pre Contrast

  5. Aortic Stenosis Congenital bicuspid aortic stenosis Normal aortic valve

  6. Mechanism of AS: LV-Ao Gradient • Consequences of LV-Ao Gradient: • late peaking Systolic murmur • Single A2 • Slow pulse upstroke

  7. Hemodynamics of AS Peak to peak pressure gradients differ between ECHO and CATH Peak instantaneous P-P LV Unshifted=larger Grad Fusmann and Feldman T, Cath and CV Int 53:553;2001

  8. Retrograde hemodynamic Assessment of Prosthetic Valves with a Pressure Wire Parham and Kern, Cath and CV Int 53:553;2001

  9. Low Gradient AS. EF 25%, no CAD. Valve replacement? P-P gradient 30mmHg CO = 3.2l/m Fick AVA = 0.7cm2

  10. Dobutamine challenge for LG AS P-P = 50mmHg CO = 4.2l/m AVA = 0.6cm2 Base 10 Dob+Pace 80 20 Dob + Pace 95

  11. What should you do with Symptomatic AS patient, low gradient, low flow? The Dobutamine Challenge AVA = 0.7cm2 AVA = 1.0cm2 Fixed area AVA = 1.5cm2 Grayburn, P. A. Circulation 2006;113:604-606

  12. AVP after 20 x 60mm Balloon. What happened? AS+AI

  13. Hemodynamics of Aortic Insufficiency • Greatest Diastolic Gradient early • Volume filling LV is rapid • LVEDP will be high unless compensated

  14. Normal LA and LV diastolic pressures LA-LV Diastolic Gradient

  15. Pressure Waves are related Chamber compliance (p/v)

  16. Hemodynamics for the Cath Lab Low Gradient AS Complications of AVP – AI AS vs. HOCM Mitral Regurgitation after MVP for MS Diastolic CHF – constrictive v Restrictive Tamponade IntracardiacShunts

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