shunt calculation, nicvd

7/27/2019 Shunt calculation, NICVD

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Shunt calculation

Dr Mohammad Ullah FirozeASSISTANT PROFESSOR

NICVD


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History

Werner Forssmann- 1929.

By the early 1940s angiography in CHD was well

established

Methodology and techniques was standardized in 1940s by

Cournand.

In the 1950s and 1960s with development of surgical

techniques, refinement and development of cardiac

catheterization was done.


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WERNER FORSSMANN


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PRINCIPLE

Identify the shunt.

Complications of shunt.

Associated lesions.

Operability.


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Precatheterization assessment

It should be goal oriented and be planned to findout the patients problem and to set the

background for future therapeutic maneuvers.

History

Physical examination

ECG

CXR

ECHO

Hb%.


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Approaches in cardiac cath

Oxymetry.

Trajectory.

Graphy.

Pressure measurement.


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Shunt calculation

Echo-

Qp/Qs

Catheterization


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Catheterization

Catheters-

a) Cournand

b) NIH

c) Multipurpose


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Oxymetry

The general rule get whatever information youcan while you are there; you may never be back.

Collect the blood samples in 7 min.

Use end hole catheter first for oxymetry and

pressure measurement , then angiography by

NIH. Start from PA-RV-RA-LA-PV-SVC-IVC-Syst.Art.


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Site Average Range

SVC 74% 67-83%

IVC 78% 65-87

RA 75 65-87

RV 75 67-84

PA 75 67-84

LA,LV,SYST. ART. 95 92-98

Normal oxygen saturations


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OXYMETRIC DETECTION OF INTRACARDIACSHUNTS

Cardiac chambersampled

% Increase OrDecrease

SVC & RA 7%

RA & RV 5

RV & PA 3

LA or PV & LV orartery

-3


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Formula for calculating blood flow

Qp=VO2/(PVsat-PAsat)(o2capacity)

Qs=VO2/(SAsat-MVsat)(o2capacity)

Qep= VO2/(PVsat-MVsat)(o2capacity)

L-R shunt=Qp-Qep

R-L shunt=Qs- Qep

Net shunt=(L-R shunt)- (R-L shunt)


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L-R shunt

PA86%

PV96%

MV76%

SA96%

Qep=2.5Qep=2.5

L-R=2.5

Qs=2.5

Qp=5.0

O2 carrying capacity=176.8

VO2=88.4

lungs

Syst. circ


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R-L shunt

PA70%

PV95%

MV70%

SA85%

Qp=2.0

Qep=2.0

Qs=3.3

Qep=2.0R-L=1.3

lungs

Syst. circ


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Bidirectional Shunt

PA86%

PV97%

SVC66%

Ao90%

Qs=2.1

Qp=4.5

L-R=2.9

R-L=0.5

Qep=1.6Qep=1.6

lungs

Syst. circ


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RESISTANCE

TPR=(PAp-PVp)/Qp

TSR=(AOp-RAp)/Qs

Unit of resistance= Hybrid resistance unit or Wood unit

Normal TSR= (9-12) infant,

(13-18) adult

Normal TPR=


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Importance of Resistance

TPR 0.7 surgery will

increase mortality or there will be no

reduction of pulm HTN.


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Reversibility of Pulm HTN

100% O2 for 10 min.

Inhalation Nitrate

I/V Prostaglandin

I/V Epinephrine

I/V Adenosine.


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High O2 Saturation in RA

ASD.

PAPVD. TAPVD.

VSD with TR

Garbodes defect.

Rupture sinus of Valsalva.


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VSD.

PDA with PR.

Coronary AV fistula.

Rupture sinus of Valsalva.

High O2 Saturation in RV


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PDA.

AP window.

High O2 Saturation in PA


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ASD

OXYGN SATURATION IN RA

CATHETER TRAJECTORY.

PRESSURE MPA. PVR.

PA GRAPHY WITH LEVOPHASE.


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ASD PRIMUM



PRESSURE MPA. PVR.



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ASD SINUS VENOSUS



PRESSURE MPA. PVR.



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PAPVD



PA GRAPHY WITH

LEVOPHASE.

PRESSURE MPA. PVR.


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VSD

OXYGN SATURATION IN RV .

LV GRAPHY.

PRESSURE MPA. PVR.



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PDA

OXYGN SATURATION IN MPA .

CATHETER TRAJECTORY-

HAIRPIN APPEARANCE

ARCH AORTOGRAPHY.

PRESSURE MPA. PVR.


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TOF

RV Graphy.

LV graphy.

Root aortography.

Arch aortography


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COARC. AORTA

PRESSURE GRADIENT.

AORTOGRAPHY

- NARROW AORTA.

- COLLATERAL

CIRCULATION.


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shunt calculation, nicvd

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