Assessment of pulmonary vascular resistance

Darshan Reddyle Roux Institute of Thoracic Surgery

Durban, South Africa

Pulmonary vascular resistance

pulmonary vascular resistance

pulmonary vascular reactivity

ratio to systemic vascular resistance

clinical evaluation non invasive investigations

operability

Wilkinson JL. Haemodynamic calculations in the catheter laboratory. Heart 2001; 85 : 113-12

Sources of errors

Correction for BSA (m2)

Unstable haemodynamicshypoventilationacidosis

Rajgopalan N et al. Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension. ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound & Allied Tech. Vol. 26, No. 5, 2009.

Rajgopalan N et al. Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension. ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound & Allied Tech. Vol. 26, No. 5, 2009.

Choice of vasodilator

100% oxygen

Nitric oxide

Resistance ratios

PVR / SVR ratio Pulmonary vascular disease

< 0.25 normal

0.25 – 0.50 moderate

> 0.75 severe

Factors in neural, hormonal and blood viscosity influences

3 year old girlCyanosisHeterotaxy syndrome - Univentricle / AVSD / MGV / PS / TAPVC

PVR = 1.15TPG = 8mmHgPA mean pressure 9

TAPVC repair and bidirectional Glenn shunt

Determinants of outcome

haemodynamic data

non-restrictive anastomosis

pulmonary vascular reactivity

non-compliant atrium / ventricular dysfunction

3 month old baby

failure to thrive tachypnoea

Echo:

Anomalous RPA arising from aorta

LA/LV volume loadingLA/Ao ratio 2.45

Severe TR PAS 78+5mmHg

Anomalous RPA from aorta

The state of the pulmonary vasculature

RPA pressuressystemicsupra-systemic

Elevated LA pressures

LPA bearing RV output

Established PVOD

Pulmonary vascular resistance

Invasive

Non-invasiveechocardiographyMRI

Conclusion

References

1. Wilkinson JL. Haemodynamic calculations in the catheter laboratory. Heart 2001; 85 : 113-120

2. Rajgopalan N et al. Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension. ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound @ Allied Tech. Vol. 26, No. 5, 2009.