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
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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
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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%
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1= Coarctation 2=Tamponade 3=Amyloid 4=EF of 10%
Abdominal aorta
Aortic valve |
Mitral annulus |
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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