Assessment of pulmonary vascular resistance Darshan Reddy le

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 (m 2) 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 = 8 mm. Hg 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+5 mm. Hg

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.