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Mohammed Almansori MBBS, FRCPC
Assistant Professor of Medicine & Interventional Cardiologist University of Dammam
ECHO CLUBINVASIVE HEMODYNAMIC EVALUATION OF
REGURGITATION
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• In every patient in whom it was considered that a decision could be reached by echocardiography alone (>80% of pts) there was 100% agreement from cardiac catheterization.
• So, in patients with adequate echo data Cath can be omitted.
• If echo indices are conflicting or significant CAD is suspected catheterization should be considered
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Indication of invasive hemodynamic evaluation:
1.When pulmonary pressure is disproportionate to the severity of regurgitation assessed noninvasively.
2.When there is a discrepancy between clinical and noninvasive findings.
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Seller’s Classification of Regurgitation.
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Reg stroke volume = Angio stroke volume – Forward stroke volume
Rough estimation of RF compared to visual interpretation:
1+ Reg is equivalent to RF of 20%2+ Reg is equivalent to RF of 20-40%3+ Reg is equivalent to RF of 40-604+ Reg is equivalent to RF of > 60%
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Hemodynamics of Mitral Regurgitation
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Prominent V wave
Peak > 40 mmHgDelta peak V wave and mean PCWP > 10 mmHgRatio peak V wave and mean PCWP > 2
It does not correlate with the presence or severity of mitral regurgitation
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A small diastolic pressure gradient may be observed across the mitral valve; however, unlike mitral stenosis, the gradient is present during early diastole only. In addition, the slope of the y descent in mitral regurgitation is steep rather than delayed, as seen in mitral stenosis.
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Camelback PA tracing
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The transmission of this pressure wave from the pulmonary veins to the pulmonary artery also explains the occasional phenomenon of a false elevation in the pulmonary artery saturation, in some cases of severe mitral regurgitation.
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In patients with only minor mitral regurgitation which is suspected to contribute to their clinical symptoms , the monitoring of invasive hemodynamic parameters (V-wave) during stress is important
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Hemodynamics of Aortic Regurgitation
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A Case of Aortic Regurgitation
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A 71-year-old man know to have moderate AR presented with a month of CCS-III angina and shortness of breath. No other medical illnesses.O/EHR 63 BP 164/53JVP 9 cm H2OEarly diastolic murmur of AR + Pansystolic murmur of MR + S3Occasional crepitation on chest auscultationNo LL edemaCXR cardiomegaly , No pulmonary edema
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Baseline ECG
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ECG in Emergency Room
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ECG Next Day in CCU
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Echo:
Normal LV function. (LVIDd 6.3cm - LVIDs 4.0cm)Moderate to severe ARModerate MR
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Coronary angiogram showed mild non-obstructive disease.
Aortic root angiogram showed severe aortic regurgitation.
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Mean PAP 42 mmHg PCWP 25 mmHgCold not get LV tracing due to catheter induced VT
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Thank you