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ECHO 2013 / Hemodynamics III Echo-Based Clinical Decision-Making Cases

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Hemodynamic Cases

Decision Making

Jae K. Oh, MD

Co-Director, Integrated CV Imaging

Director, Pericardial Diseases Clinic

Oh.jae@mayo.edu

State of the Art in Echo

April 3rd, 2013

©2012 MFMER | 3225607-1

Doppler Echocardiography

Learning Goal

“Learn How To Explain Every

Doppler Signal Based on

Underlying Hemodynamics”

PV Doppler

©2012 MFMER | 3225607-2

Doppler Hemodynamics Review

Doppler principles

All formulae

Bernoulli’s equation

Hydraulic orifice formula

Continuity equation

PISA

Qp/Qs

dP/dt

PHT and DT

©2011 MFMER |

slide-3 ©2012 MFMER | 3225607-3

Doppler Hemodynamic Formulae

Pressure gradient = 4 x velocity2 = (2 x velocity)2

Flow rate = Area x Velocity

Volume = Area x Time velocity integral (TVI)

Continuity equation and PISA

Flow in = Flow out

AVA = LVOT area x LVOT tvi / AV tvi

ERO = 6.28 x radius2 x Aliasing vel / MR vel

Pressure half time (PHT) = 0.29 x DT

MVA = 220 /PHT

©2011 MFMER |

slide-4 ©2012 MFMER | 3225607-4

How to Measure LA /LVD pressure ?

E/e’

MR velocity 2 x 4 = LV pressure – LA pressure

LA pressure = LV pressure – (MR velocity2 x 4)

PFO velocity 2 x 4 = LA pressure – RA pressure

LA pressure = (PFO velocity 2 x 4) + RAP

AR Diastolic velocity2 x 4 = Diastolic BP - LVDP

LVDP = Diastolic BP – (AR Diastolic velocity2 x 4)

©2012 MFMER | 3225607-5

Hydraulic Orifice Formula

A

V

Flow = Area Velocity

Time

TVI

V

Volume = Area TVI

TVI = time velocity integral

CP1065814-7

©2012 MFMER | 3225607-6

PW Doppler recording from LVOT are shown. What is the underlying condition?

LVOT diameter =2cm

1= Coarctation 2=Tamponade 3=Amyloid 4=EF of 10%

©2012 MFMER | 3225607-7

1= Coarctation 2=Tamponade 3=Amyloid 4=EF of 10%

Abdominal aorta

Aortic valve

Mitral annulus

©2012 MFMER | 3225607-8

Pulsus Alternans Treated in 60 yo man

TVI 11 cm

TVI 30 cm

HR 120

HR 40

 

Cardiac Output is improved by 1= x1 2= x2 3= x3 4= x4

©2012 MFMER | 3225607-9

Use of Pressure Half-time

Mitral Valve Stenosis

Longer with more severe MS

Indirect measure

Aortic Valve Regurgitation

Shorter with more severe AR

Indirect

Diastolic Filling Pressure

Use DT , not PHT

Shorter with increased filling pressure

Indirect

©2012 MFMER | 3225607-10