1 / 29

Hemodynamics: essentials for future TAVR and mitral valve disease

Hemodynamics: essentials for future TAVR and mitral valve disease. Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief Cardiology University California Irvine Orange, California. Etiology of Aortic Stenosis From the Euro Heart Survey.

jase
Download Presentation

Hemodynamics: essentials for future TAVR and mitral valve disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hemodynamics: essentials for future TAVR and mitral valve disease Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief Cardiology University California Irvine Orange, California

  2. Etiology of Aortic Stenosis From the Euro Heart Survey Goldbarg, S. H. et al. J Am Coll Cardiol 2007;50:1205-1213

  3. Pathophysiology of AS J Am Coll Cardiol. 2012;60(3):169-180.

  4. 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

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

  6. 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

  7. Hemodynamic Technique Peak instantaneous vs P-P P-P grad Mean Grad LV Unshifted=larger Grad Fusberg and Feldman T, Cath and CV Int 53:553;2001

  8. Techniques for Aortic Valve Gradient Measurement • Single Catheter LV-Ao pullback • LV and Femoral Sheath • LV and Long aortic sheath • Bilateral femoral access • Double-lumen pigtail catheter • Transeptal LV access with ascending Ao • Pressure Guidewire with ascending Ao • Multi-transducer micromanometer catheters Fusberg and Feldman T, Cath and CV Int 53:553;2001

  9. AVA: Gorlin equation AVA: Hakke formula (“poor man’s Gorlin”) Assumes HR*SEP*44.3 = 1000 in most patients Valid for HR ~65-100 AVA = cardiac output (L/min)/√Peak-Peak Pressures Calculating Aortic Valve Area

  10. Grading Severity of Aortic Stenosis AVA AVA Index Aortic Stenosis (cm2) (cm2/m2) Mild >1.5 >0.9 Moderate 1.1-1.5 >0.6-0.9 Severe <0.8-1.0 <0.4-0.6

  11. Hemodynamic Differentiation of LVOT Obstruction • 3 Differentiating features • Aortic upstroke • Pulse pressure • Contour –spike/dome AS HOCM

  12. Low Gradient, Low EF AS? LVEF 25% P-P gradient 30mmHg CO = 3.2l/m Fick AVA = 0.7cm2

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

  14. 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

  15. CoreValve PHV Edwards-Sapien PHV Chiam, P. T.L. et al. J Am Coll Cardiol Intv 2008;1:341-350

  16. Pre- Post 26mm Sapien Edwards Anachrotic shoulder, dichrotic notch Diastolic dysfunction? Delayed upslope

  17. AS+AI

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

  19. PCW does not always equal LA

  20. Hemodynamics and Doppler Echo findings before MVBP

  21. Hemodynamic and Doppler Echo findings after MVBP

  22. Hemodynamics for Structrual Heart Disease Low Gradient AS Complications of AVP – AI AS vs. HOCM Mitral Regurgitation after MVP for MS Diastolic CHF – constrictive v Restrictive Tamponade For your own review consider Intracardiac Shunts

More Related