PowerPoint Presentation

30TH Echo Club Meeting

DR : Fatema QaddouraConsultant CardiologistKFMMCHistory 55 year old F K/C of SC trait RHD, MVD- sever MR,CAD Pt underwent MV repair,2007 Regular F/U in OPD, pt. was asymptomatic, with clinical evaluations & Echo studies. The Pt presented with progressive SOB over the last 2months NYHA class IV.Hospital progressFound to have Hb of 6 g%2units of blood Tx. was givenPatient was completely asymptomatic

TTEModerate MRModerate plus TR with significant PHTIs it 2ndary to Pure MR or +/- SC traitEcho Results2006200720082009201020113/2013RV size31303233313838LV size51/ 3851/3251/4051/3953/3949/3553/39RA35343434333448LA38354143414443PAP40-3438297085MR3122222TRTTTTT23What to do next?

What to do next?MVRInvasive assessment of MRTEEMedical Rx. With diuretics and vasodilatorsTEE

TEEModerate Sever MRWhat is the next step?

What to do next?MVRInvasive assessment of MRMedical Rx. With diuretics and vasodilatorsInvasive procedure Pressure abnormalities Ventriculography The classically taught hemodynamic abnormality of mitral regurgitation is the presence of a prominent v wave on the PCWPInvasive procedure

Invasive procedure

Definition of prominent v wavepeak v wave in excess of 40 mmHg, a difference between the peak v wave and mean PCWP >10 mmHg orthe ratio of the peak v wave to mean PCWP >2 v wave height three times the mean PCWP is virtually diagnostic of severe, acute mitral regurgitation.In one study of over 900 patients the presence of a prominent v wave was insensitive and had a poor positive predictive value for the presence of moderate or severe mitral regurgitationIn another study One third of patients with chronic mitral regurgitation demonstrating trivial v waves, despite severe mitral regurgitationAm J Cardiol 1994;73:568570Am J Cardiol 1982;49:849854A wave is generally not affected. In cases of pure MR, the Y descent in the pulmonary capillary wedge pressure is rapid (pseudoconstriction pattern).in patients with mixed mitral valve disease, the Y descent is gradual.A brief early diastolic pressure gradient between LA and LV may occur in patients with isolated severe MR

Left Ventriculograms

LV angiogram

Grading of MR

Final Dx. Moderate sever MR Moderate TR, sever PHT with dilated RV Sickle cell Trait Multifactorial PHTFinal planFor MVR and TV repair

In summery :Step by step evaluation Use all modalities to reach your conclusionShare with your team At the end you did your part and hope your decision was the best choice for the patient

Thank you