Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics
description
Transcript of Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics
Effects of endovascular treatment of thoracic aortic
diseases on aortic hemodynamics
UNIFESP
Diego Gaia MD [email protected]
Diego Gaia MD [email protected]
Input impedance: in practice ?
Z = P/Q
time (s)0.0 0.2 0.4 0.6 0.8
blo
od
pre
ssu
re (
mm
Hg
)
70
80
90
100
110
120
time (s)0.0 0.2 0.4 0.6 0.8 1.080
100
120
140
160young subject (C-type) old subject (A-type)
contribution of reflected wave
contribution of reflected wave
measured pressure
measured pressure
Wave reflection
• explains patho-physiological changes in blood pressure
• early return of reflected wave: ‘boost’ of systolic pressure
• extra load on the heart
• What is the influence of aortic prosthesis / stent-graft placement ?
Type B / DTA
PWV / Impedance / PP / Aix / Reflexion
• Day before• During procedure
• 1 PO• 7 PO
• 30 PO• 60 PO
• 180 PO• 360 PO
Pulse tonometry
Flow: Echocardiogram
Pressure and flow: before and after endoprosthesis deployment
Before After
Pressure:
Flow:
time (s)0.0 0.2 0.4 0.6 0.8
blo
od
pre
ssu
re (
mm
Hg
)
70
80
90
100
110
120
time (s)0.0 0.2 0.4 0.6 0.8 1.080
100
120
140
160young subject (C-type) old subject (A-type)
contribution of reflected wave
contribution of reflected wave
measured pressure
measured pressure
Type B Dissections
23 %
34 %
DTA
Pulse Wave Velocity – Femoral / Carotid
20 %
Conclusions
• Aortic stiffness MACE
• Stent-graft can increase aortic stifness and left ventricular afterload (Impedance/PWV)
• Negative cardiovascular impact
• Device improvementos – compliance / stiffness