effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics
DESCRIPTION
Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics. UNIFESP. Diego Gaia MD PhD [email protected]. Input impedance: in practice ?. Z = P/Q. Wave reflection. explains patho-physiological changes in blood pressure - PowerPoint PPT PresentationTRANSCRIPT
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