invasive hemodynamics assessment of aortic stenosis · 2019-10-31 · aortic stenosis 1) perform...
TRANSCRIPT
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INVASIVE HEMODYNAMICSASSESSMENT OF AORTICSTENOSISSTENOSIS
PRAVEEN PANGULURI
OCTOBER 29, 2019
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ROLE OF LHC INAORTIC STENOSIS
1) Perform when discrepancy between echo findings andpatient’s symptoms
2) Measure gradient across aortic valve and calculate aorticvalve areasvalve areas
3) Identify level of obstruction
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AV STUDY METHODS
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LHC BASICS
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LHC BASICS
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AV GRADIENTMEASUREMENTS
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AORTIC VALVEGRADING
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AVA EQUATIONS
Gorlin Equation
Hakki Equation
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LOW OUTPUT LOW GRADIENTAORTIC STENOSIS EVALUATION
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PARADOXICAL LOW GRADIENTAORTIC STENOSIS WITH NORMALLVEF
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LOCATION OFOBSTRUCTION
Supravalvular stenosis
Valvular stenosis
Subvalvular stenosis
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BROCKENBROUGH-BRAUNWALD-MORROW SIGN
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ARTIFACTS
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DAMPENING
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DAMPENING
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PVC GRADIENTS
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IMPROPRE POSITION
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PERIPHERAL AMPLIFICATION
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CARABELLO SIGN
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TIPS AND TRICKS
- Flush catheters frequently
- Ensure transducer height at level of heart
- Zero transducers prior to measuring pressures
- Understand catheter waveforms and expected deflections
- Monitor for unexpected waveform changes frequently
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LHC IN CHRONIC AORTICREGURGITATION
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LHC IN ACUTE AORTICREGURGITATION
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LHC IN AORTICREGURGITATION ASSESSMENTPOST TAVR
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AR INDEX POST TAVR