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Valvular Hemodynamics Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief...
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Valvular Hemodynamics Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief Cardiology University California Irvine Orange, California
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Transcript of Valvular Hemodynamics Morton J. Kern, MD Professor of Medicine Chief of Cardiology Associate Chief...
Valvular Hemodynamics
Morton J. Kern, MDProfessor of Medicine
Chief of CardiologyAssociate Chief CardiologyUniversity California Irvine
Orange, California
Hemodynamic Problems for the Cath Lab
• Valvular heart disease:• Aortic stenosis/insufficiency• Mitral stenosis/insufficiency
• Intraventricular gradients• Pericardial effusion/tamponade• Constrictive/restrictive physiology• Coronary Hemodynamics• Intracardiac Shunts
Tri/MV valves open
Pa/Ao valves are closed
Pa/Ao valves open
Tri/MV valves close
Pa/Ao valves close
Tri/MV valves opensystole
=Valve action
BAMC Case #3117: Patient: 61 yo maleDx: 3V CAD filter: 50 Hz/ sample 250 Hz
Pre ContrastNormal LV and Aortic Pressure Fluid-filled system micromanometer transducers Fluid filled, FA sheath
Normal aortic valve Congenital bicuspid aortic stenosis
Aortic Stenosis
Mechanism of AS: LV-Ao Gradient
Consequences of LV-Ao Gradient:
1. late peaking Systolic murmur
2. Single A23. Slow pulse upstroke
LV
Fusmann and Feldman T, Cath and CV Int 53:553;2001
Hemodynamics of ASPeak to peak pressure gradients differ between ECHO and CATH
Peak instantaneous P-P
Unshifted=larger Grad
Parham and Kern, Cath and CV Int 53:553;2001
Retrograde hemodynamic Assessment of Prosthetic Valves with a Pressure Wire
Low Gradient AS. EF 25%, no CAD. Valve replacement?
P-P gradient 30mmHgCO = 3.2l/m FickAVA = 0.7cm2
Base 10 Dob+Pace 80 20 Dob + Pace 95
Dobutamine challenge for LG AS
P-P = 50mmHgCO = 4.2l/m
AVA = 0.6cm2
Grayburn, P. A. Circulation 2006;113:604-606
What should you do with Symptomatic AS patient, low gradient, low flow? The Dobutamine Challenge
AVA = 0.7cm2
AVA = 1.0cm2
AVA = 1.5cm2
Fixed area
AVP after 20 x 60mm Balloon. What happened?
AS+AI
Hemodynamics of Aortic Insufficiency• Greatest Diastolic Gradient early • Volume filling LV is rapid• LVEDP will be high unless
compensated
Normal LA and LV diastolic pressures LA-LV Diastolic Gradient
Pressure Waves are related Chamber compliance (p/v)
Hemodynamics for the Cath Lab
Low Gradient ASComplications of AVP – AIAS vs. HOCMMitral Regurgitation after MVP for MSDiastolic CHF – constrictive v RestrictiveTamponadeIntracardiac Shunts
