Assessment of pulmonary vascular resistance by 1j078e

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									Assessment of pulmonary
   vascular resistance



                                   Darshan Reddy
             le Roux Institute of Thoracic Surgery
                             Durban, South Africa
Pulmonary vascular resistance
pulmonary vascular resistance

                                   ratio to systemic vascular resistance

 pulmonary vascular reactivity




                            operability



      clinical evaluation               non invasive investigations
Wilkinson JL. Haemodynamic calculations in the
catheter laboratory. Heart 2001; 85 : 113-12
             Sources of errors

Correction for BSA (m2)

Unstable haemodynamics
    hypoventilation
    acidosis
Rajgopalan N et al. Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension.
      ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound & Allied Tech. Vol. 26, No. 5, 2009.
Rajgopalan N et al. Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension.
      ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound & Allied Tech. Vol. 26, No. 5, 2009.
          Choice of vasodilator

100% oxygen

Nitric oxide
                  Resistance ratios
PVR / SVR ratio                      Pulmonary vascular disease

  < 0.25                                    normal

  0.25 – 0.50                               moderate

  > 0.75                                    severe



Factors in neural, hormonal and blood viscosity influences
3 year old girl
Cyanosis
Heterotaxy syndrome - Univentricle / AVSD / MGV / PS / TAPVC
PVR = 1.15
TPG = 8mmHg
PA mean pressure 9
TAPVC repair and bidirectional Glenn shunt
       Determinants of outcome

haemodynamic data

non-restrictive anastomosis

pulmonary vascular reactivity

non-compliant atrium / ventricular dysfunction
3 month old baby

failure to thrive
tachypnoea




Echo:

Anomalous RPA arising
from aorta

LA/LV volume loading
LA/Ao ratio 2.45

Severe TR
PAS 78+5mmHg
Anomalous RPA
from aorta
    The state of the pulmonary vasculature

RPA pressures
  systemic
  supra-systemic

Elevated LA pressures

LPA bearing RV output

Established PVOD
   Pulmonary vascular resistance

Invasive

Non-invasive
           echocardiography
           MRI
Conclusion
                    References
1. Wilkinson JL. Haemodynamic calculations in the catheter
   laboratory. Heart 2001; 85 : 113-120
2. Rajgopalan N et al. Noninvasive Estimation of Pulmonary
   Vascular Resistance in Pulmonary Hypertension.
   ECHOCARDIOGRAPHY: A Jrnl of CV Ultrasound @ Allied Tech.
   Vol. 26, No. 5, 2009.

								
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