invasive hemodynamics assessment of aortic stenosis · 2019-10-31 · aortic stenosis 1) perform...

INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS PRAVEEN PANGULURI OCTOBER 29, 2019

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Page 1: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

INVASIVE HEMODYNAMICSASSESSMENT OF AORTICSTENOSISSTENOSIS

PRAVEEN PANGULURI

OCTOBER 29, 2019

Page 2: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

ROLE OF LHC INAORTIC STENOSIS

1) Perform when discrepancy between echo findings andpatient’s symptoms

2) Measure gradient across aortic valve and calculate aorticvalve areasvalve areas

3) Identify level of obstruction

Page 3: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

AV STUDY METHODS

Page 4: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LHC BASICS

Page 5: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LHC BASICS

Page 6: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

AV GRADIENTMEASUREMENTS

Page 7: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

AORTIC VALVEGRADING

Page 8: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

AVA EQUATIONS

Gorlin Equation

Hakki Equation

Page 9: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LOW OUTPUT LOW GRADIENTAORTIC STENOSIS EVALUATION

Page 10: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

PARADOXICAL LOW GRADIENTAORTIC STENOSIS WITH NORMALLVEF

Page 11: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LOCATION OFOBSTRUCTION

Supravalvular stenosis

Valvular stenosis

Subvalvular stenosis

Page 12: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

BROCKENBROUGH-BRAUNWALD-MORROW SIGN

Page 13: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

ARTIFACTS

Page 14: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

DAMPENING

Page 15: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

DAMPENING

Page 16: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

PVC GRADIENTS

Page 17: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

IMPROPRE POSITION

Page 18: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

PERIPHERAL AMPLIFICATION

Page 19: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

CARABELLO SIGN

Page 20: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

TIPS AND TRICKS

- Flush catheters frequently

- Ensure transducer height at level of heart

- Zero transducers prior to measuring pressures

- Understand catheter waveforms and expected deflections

- Monitor for unexpected waveform changes frequently

Page 21: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LHC IN CHRONIC AORTICREGURGITATION

Page 22: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LHC IN ACUTE AORTICREGURGITATION

Page 23: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

LHC IN AORTICREGURGITATION ASSESSMENTPOST TAVR

Page 24: INVASIVE HEMODYNAMICS ASSESSMENT OF AORTIC STENOSIS · 2019-10-31 · AORTIC STENOSIS 1) Perform when discrepancy between echo findings and patient’s symptoms 2) Measure gradient

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