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Cardiology
Valvular Heart Disease Measurement of Valve Orifice Area and Quantification of Regurgitation
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 85 slides
Principles of invasive valve assessment
- Scope of invasive valve assessment
- Historical development of cardiac catheterization
- Displacement of invasive hemodynamics by Doppler
- Guideline position on invasive assessment
- Consequences of declining hemodynamic practice
- Pressure gradient and flow across a stenotic valve
- Hydraulic principle behind valve area
- Conversion of pressure gradient to velocity
Aortic stenosis: recording an accurate gradient
- Requirements for an accurate transaortic gradient
- Limitations of the pullback gradient
- Catheter positions for recording a transvalvular gradient
- Subvalvular gradient within the left ventricle
- Micromanometer tracings showing the intraventricular gradient
- Femoral sheath as the distal pressure site
- Correct distal catheter placement
- Transducer calibration against a mercury manometer
- Two tenets when using internal calibration
- Troubleshooting non-identical pressures
- Recorder offset for femoral pressure
Cardiac output and the Gorlin formula
- Cardiac output as the second key datum
- Components of the arteriovenous oxygen difference
- Assumed versus measured oxygen consumption
- Thermodilution cardiac output
- Sources of error in thermodilution
- The Gorlin formula
- Discharge coefficients and the flow term
- Aortic valve area equation
- Derivation of the empirical constant
- Absence of an aortic empirical constant
- Flow dependence of calculated aortic valve area
- Projected valve area at normal flow
Defining severe aortic stenosis
- Guideline criteria for severe aortic stenosis
- Discordance between valve area and gradient
- Valve area plotted against mean pressure gradient in aortic stenosis
- Status of valve area in current guidelines
- Outcome of aortic valve replacement
- Low-gradient, low-ejection-fraction aortic stenosis
- Definition and role of inotropic reserve
- Outcomes after transcatheter replacement by inotropic reserve
- Pseudo-aortic stenosis
- Management of pseudo-severe aortic stenosis
- Survival with conservatively treated pseudo-severe aortic stenosis
- Advantages of the cath lab for inotropic challenge
Mitral, tricuspid and pulmonic stenosis
- Requirements in mitral stenosis
- Wedge pressure as a left atrial surrogate
- Oximetric confirmation of the wedge position
- Calibration tolerance in mitral stenosis
- Gorlin formula in mitral stenosis
- Reasons for better agreement at the mitral valve
- Hakki formula
- Tricuspid stenosis
- Severity thresholds in tricuspid stenosis
- Pulmonic stenosis
Quantification of valvular regurgitation
- Accuracy of regurgitant lesion assessment
- Role of cardiac magnetic resonance
- Contributions of the catheterization laboratory
- Hemodynamic waveform in aortic regurgitation
- Simultaneous ventricular and femoral pressures in aortic regurgitation
- The V wave in mitral regurgitation
- Aortographic grading of aortic regurgitation
- Aortography technique
- Ventriculography in mitral regurgitation
- Obtaining a diagnostic ventriculogram
- Volumetric quantification of regurgitation
- Regurgitant fraction thresholds
- Exercise testing during hemodynamic recording
- Interpretation of the handgrip response
Indications for surgery and summary
- Indications for surgery in regurgitant lesions
- Hemodynamic patterns in unexplained dyspnea
- Ejection fraction thresholds for intervention
- Summary of the diagnostic pathway
- Key points to carry forward
- References
- References
- References
- References
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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