ECHO 2013 / Hemodynamics III Echo-Based Clinical Decision-Making Cases
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67 year old man with SOB
Severe AS ? with low gradient and normal EF
LVOT D 1.9 cm |
LVOT TVI 21 cm |
Mean Gr 26 mmHg
Stroke volume = (1.9)2 x 0.785 x 21 = 60 cc AVA = 60 / 76 = 0.79 cm2
©2012 MFMER | 3225607-21
67 year old man with SOB
What would be the best next step ?
LVOT D 1.9 cm |
LVOT TVI 21 cm |
Mean Gr 26 mmHg |
1. |
Hemodynamic cath |
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AVA = 0.8 cm2 |
2. |
AVR |
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3. |
Diastolic function |
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assessment |
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4. |
Evaluation of non- |
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cardiac cause |
©2012 MFMER | 3225607-22
67 year old man with SOB Diastolic function assessment
What about now?
1=Hemodynamic cath 2=ACEi and diuretic 3=AVR
4=Heart Transplantation
Medial
8 cm/s
Lateral
6 cm/s
©2012 MFMER | 3225607-23
67 year old man with heart failure Mitral Annulus Tissue Doppler
What is the underlying problem? 1=Diastolic dysfunction 2=Hypertensive Heart 3=Radiation Heart 4=Restrictive CM
Medial
8 cm/s
Lateral
6 cm/s
©2012 MFMER | 3225607-24
67 year old man with heart failure Hepatic Vein Doppler c/w constriction
Radiation Heart Disease
©2012 MFMER | 3225607-25
Referred for mitral valve repair
1.Surgical consultation for MVR
2.LV gram
3.More quantitation
4.Follow-up in 1 year
©2012 MFMER | 3225607-26
Referred for MV Repair
Radius = 9 mm
ERO = ( 0.92 / 2) = 0.4 cm2
1= MVR 2= Follow-up 3=More eval
©2012 MFMER | 3225607-27
Color M mode and CW Doppler
Mitral Regurgitation
©2012 MFMER | 3225607-28
Mitral Regurgitation Severity
ERO = 0.4 cm 2
MR volume = 0.4 x 100 = 40 cc
1= Mild 2= Moderate 3= Severe 4=Surgical
©2012 MFMER | 3225607-29
Diastolic Function Assessment
E= 160 cm/s |
E’ = 5 cm/s |
©2012 MFMER | 3225607-30