2. Memorandum: 1) per la valutazione della severità della SVA non basta la stima del gradiente e della velocità transvalvolare 2) La severità della SVA è data dalla misura dell’area valvolare Metodi per la stima dell’area valvolare: Area anatomica Equazione di continuità
3.
4. Continuity Equation LVOT flow = AV flow = A AV x TVI AV A LVOT x TVI LVOT A AV = (A LVOT x TVI LVOT ) / TVI AV CP1061805-18 TVI LVOT By PW A LVOT V AV A AV V LVOT Time TVI AV By CW Time
15. Pressure Recovery Più il flusso si avvicina all’orifizio stenotico più aumentà la velocità (Energia cinetica) e si riduce la pressione (energia potenziale). A livello della stenosi sarà quindi massima la velocità e minima la pressione. Subito a valle della stenosi inizia il processo inverso: si riduce la velocità ed aumenta la pressione.
38. Altre modalità di valutazione della funzione sistolica globale del V. Sx
39.
40. Rischio bassa portata post CCH per ostruzione intraventricolare ( I.V.A.F.V.: intraventricular abnormal flow velocity)
41.
42. MORBILITA’ PERIOPERATORIA POST SVA (casistica MCH 2005) BASSA PORTATA (Tot. 105 : 30 %) 5 3 16 81 (77 %) (15 %) (5 %) (3 %) N.B.: I Pazienti a maggior rischio sono quelli con F.E. > 50% !!!!
51. Among 135 patients with normal exercise test 67 had an event (AVR for symptoms or cardiovascular death) at a mean follow-up of 20+14 months. The variables independently associated with events were: . age ≥65 years, . diabetes, . LV hypertrophy, . resting mean gradient > 35 mmHg . exercise-induced increase in mean gradient > 20 mmHg
56. Non dimenticare che il gradiente è flusso dipendente e che perciò un gradiente basso non significa necessariamente stenosi non critica Oltre alla F.E. valuta perciò anche la gittata sistolica e il postcarico del V. Sx
Editor's Notes
Raster Image \\rasters\\mays03.tif
CP1061805 Oh,JK CW 5-13-2002 Apical 60%, Right parasternal 19%, Subcostal 8%, SSN 6%, Rt Supraclavicular 5%, Left parasternal 2%
Variation of energy loss as a function of EOA (left) when AA remains constant and as a function of AA (right) when EOA remains constant. Transvalvular flow rate was assumed to be 250 mL/s.
Characterization of 512 consecutive patients with severe AS (AVAi <0.6 cm2/m2) and preserved ejection fraction (>0.50) based on for SVi > or ≤35 mL/m2 and mean pressure gradient > or ≤40 mmHg (data taken from Hachicha et al.2). AVA, aortic valve area; AVR, aortic valve replacement; LVEDD, left ventricular end-diastolic diameter; LVDEVI, left ventricular end-diastolic volume index; SVi, stroke volume index; Zva, valvulo-arterial impedance.
Overall survival in the four groups of patients (Figure 2) as a function of the type of treatment: medical vs. surgical (data taken from Hachicha et al.2).
TEE imaging study to be obtained in the following views (pre-procedure): A. The 5-chamber view (Omniplane 0°) with the aortic valve in the center of the screen Mandatory views: Standard 2D imaging Zoom mode of LVOT and AV (ensure maximum width of LVOT, AV, and aortic sinuses) CFD to demonstrate any AR jet(s) Zoom mode to show MV leaflets CFD for MR (zoom mode on MR jet) Pull back to image aortic root and proximal portion of ascending aorta 2D imaging of LV at mid-papillary muscle level (short axis) 2D imaging of descending aorta (short axis) B. The longitudinal imaging plane (Omniplane 90°) with the aortic valve and ascending aorta shown horizontally. Mandatory views: 2D imaging of AV 2D of aortic valve with CFD Zoom mode on AV Zoom mode on AV with CFD to assess presence and/or determine origin of AR 2D imaging of MV and CFD to determine MR Zoom image of LAA
Event-free survival as a function of the level of rest mean gradient (A), increase in gradient during exercise (B), and combination of rest gradient and exercise-induced increase in gradient (C). MG, mean gradient; Exer. ΔMG, exercise-induced increase in mean gradient.