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PPM

PPM. HOW IMPORTANT. THE WORLD IS FLAT NO ONE REALLY LANDED ON THE MOON OBSTRUCTION IN AS IS AN INNOCENT BYSTANDER. BLAIS et al. WHY THE CONTROVERSEY?. DEFINITION : AVA/BSA. VARIATION IN O2 CONSUMPTION. 65 TO 250 ml/min/M 2. GRADIENT.

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PPM

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  1. PPM HOW IMPORTANT

  2. THE WORLD IS FLAT • NO ONE REALLY LANDED ON THE MOON • OBSTRUCTION IN AS IS AN INNOCENT BYSTANDER

  3. BLAIS et al

  4. WHY THE CONTROVERSEY? • DEFINITION : AVA/BSA

  5. VARIATION IN O2 CONSUMPTION • 65 TO 250 ml/min/M2

  6. GRADIENT • VARIES WITH THE SQUARE OF OUTPUT ( G = CO2 x AVA2)

  7. AS DOES NOT KILL BY MAGIC IT’S THE OBSTRUCTION TO OUTFLOW STUPID

  8. IF YOU REMOVED THE STENOTIC VALVE FROM A PATIENT AND RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

  9. 40 Mm Hg POST- OP GRADIENT • IT WILL VARY WITH THE SQUARE OF THE OUTPUT. IF THE OUTPUT DOUBLES, THE GRADIENT WILL BECOME 160 mm Hg

  10. NOW WHAT • 1. R/O A FALSE GRADIENT (BILEAFLET VALVES). • ASSESS VALVE FUNCTION • CATH IF NECESSARY

  11. ECHO • PV MOVEMENT NL • JET 3.1 m/sec • AVA 0.9 cm2 • EF 0.2

  12. GIVEN A LARGE GRADIENT DOES EXIST NOW WHAT?

  13. EVALUATE as NEW CASE OF AS • SYMPTOMS • EXERCISE • FUNCTION

  14. TRIAL OF BETA BLOCKADE

  15. NOW EVALUATE THE RISK OF A REDO WITH ROOT ENLARGEMENT OR A DIFFERENT VALVE

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