Circulations de Fontan: un equilibre précaire?
|
|
|
- Edgar Robertson
- 5 years ago
- Views:
Transcription
1 Martinique 2015 Session Fontan Circulations de Fontan: un equilibre précaire? Marc Gewillig, MD, PhD Louvain, Belgique
2 Normal biventricular circulation Ao 0utput % RA pressure low PA pulsatility LV S LV Ao sat > 95% PA RV P RA LA Gewillig TCS 2000
3 Fontan circulation: new portal system V Ao V 0utput (50) % CV pressure high PA pulsatility Ao sat (80-)93% CV PA LA Portal system : dam congestion output continuous decreased Gewillig TCS 2000
4 Effect of a dam Upstream : en amont congestion Dam use: continuous flow inertion, non-pulsatile Downstream en aval controlled & decreased flow
5 Exercise & CO: Nl vs Fontan circulation N EF 70% Cardiac Output % of nl baseline Better Fontan Poor Fontan Exercise level Gewillig ICVTS 2010
6 Fontan : progressive undoing Glenn Fontan Systemic Output % of nl saturation % Good Fontan Bad Fontan 40 CVP mmhg Fenestration size % of conduit Gewillig Goldberg 2014
7 The Fontan dilemma Normal biventricular No compromise Fontan circulation Compromise And full saturation And full output And no congestion Or good saturation Or good output & only moderate congestion f Ω of neo-portal Fontan
8 Management of Fontan failure low output Fontan portal connection congestion Fontan portal connection Neutralise? Ao V suction < -10 mmhg V V Heart? Keep LAP low, but Deprived for BSA Deprived for size : overgrown ² CV PA Neutralise : no Attenuate : very little?!? LA Aggravate : yes Acute little - no suction Chronic compliance
9 Fontan CO : EF - PVR 100 normal LV Circulatory Output % of nl at rest F PVR 1.5 F PVR 2.5 F PVR Theoretical concept - Experience based - To be refined EF of UVH % Gewillig ICVTS 2010
10 Fontan CO : EF - PVR 100 normal LV Circulatory Output % of nl at rest F UVH 70% F UVH 50% F UVH 30% Theoretical concept - Experience based - To be refined PVR Gewillig ICVTS 2010
11 Fontan : evolution of PVR 5? Medication? 4 PVR 3 normal age Gewillig ICVTS 2010
12 Fontan: effect of damming by portal system Primary effects Upstream: congestion Lung: low flow with inertia (continuous non-pulsatile) Downstream: decreased flow Secundary effects Congestion Oedema, ascites Lymphatic system: PLE, bronchial cast Liver fibrosis, cirrosis, CA PVR (low flow, no pulsatility, absence high flow high pressure, vasoactors) Ventricle Systole: contraction Diastole: suction compliance filling pressure SVR ventriculo-arterial coupling Collaterals : veno-venous, arterio-arterial Humoral : homeostatic reactions
13 UVH : a ventricle with a history Dilated? Decrease preload Decrease afterload Increase contractility Collapsed? Increase preload Afterload required Contractility: Frank-Starling failing pressure/volume loop Normal LV UVH fetal UVH shunted UVH Fontan
14 Ventricular compliance: effect chronic preload 20 15? Medication? normal acute overload V EP mmhg chronic overload chronic excessive overload acute underload chronic underload overgrown Preload % of nl Gewillig ICVTS 2010
15 UVH: pulmonary flow < growth PA normal PA Growth f flow : 4 phases shunt PA in UVH Fetus Initial palliation After PCPC - Glenn After TCPC - Fontan 100% Glenn Fontan Flow after Fontan birth Chronic low flow No pulsatility, very steady Absence episodes high flow pressure Inhomogenous distribution hepatic factor X Collateral flow PVR
16 Fontan circulation : after 45 years 1980 s Heart failure Congestion Low output Fontan ventricle Black box : Big cavity, thick wall Dysfunctional S & D No control on Output Congestion Circulation failure Fontan portal system Congestion Low output Ventricle can aggravate Ventricle: 2 key issues previously overloaded Overgrown Overdilation < damage Now chronicly deprived No preload reserve No control
17 Neo-portal Fontan system Connection : TCPC No gradient Minimal turbulence & flow collision; hepatic X-factor to both lungs Lungs PVR as low as possible; capacitance; recruitment Reasons increased PVR: Hypoplasia, stenosis, kink, loss of segments PVD (micro)thrombi PV stenosis Collateral flow Vasoconstriction : primary vs secundary
18 Neo-portal Fontan system Increase transpulmonary flow Optimise Fontan connection : reconvert, streamline Dilate stent PA stenosis, occlude collaterals Dilate stent PV «stenosis» compression Pulmonary vasodilators : Mitchell 2004 at HTX: PVR WU/m 2!!! Oxygen NO Ca blocker Prostacyclin Endothelin A antagonist altitude Sildenafil Treprostinil, inhaled Iloprost Limited effect!! Bosentan, Sitaxsentan, Ambrisentan Anticoagulation Ventricular suction enhance?? Very limited effect!!
19 Fontan failure : management Prevention : avoid pulmonary artery hypoplasia Prevention : avoid PA distortion, kink, loss Prevention : avoid PVD Prevention : avoid excessive ventricular overload Prevention :.. Prevention : avoid energy loss in CPC Symptomatic : decrease congestion Curative : decrease PVR: goal % ; current 0-10% Curative : decrease LAP: goal - 10 mmhg ; current 0 (- 2) Bypass Fontan : fenestration Assist - Replace
20 The search for excellence Haute cuisine kitchen Choose products Timing Prepare: filer, ripening, fermentation, marinating, mellow, paner, glacer, larder, mariner, degorger ; cuire, blancher, fondu, friter, flamber, pocher, papillotte, poeller, rotir, griller, barder, gratiner, braiser, sauter, fumer, deglacer, sous vapeur Measure t Adapt temperature, time of cooking Taste Salt, pepper, herbs, spice Avoid failure; failure no option No need for sauce mayonaise ketchup Congenital heart disease Born ; no choice 1st palliation Accept wide variety of result No little control Glenn at standard time No mortality, only excessive cyanosis Fontan at standard time Await result ; failure is an option Search for medication
21 UVH : Pulmonary flow Volume load shunt Medication?? normal PA PA in UVH PA hypoplasia 100% Glenn Fontan birth time Gewillig ICVTS 2010
22 Management of UVH to Fontan Decisions, in order of importance: 1. Initial palliation: quality of procedure PA growth 2. Timing of Glenn: stops catch-up growth PA s Consider second wind, mixed Glenn
23 UVH : Pulmonary flow Volume load shunt normal PA PA in UVH PA hypoplasia PA hypoplasia Shunt 100% Glenn Fontan birth time Gewillig ICVTS 2010
24 Stretch GT stent expansion: bench test 3.5 mm GT < 4.5 stented graft 4.0 mm GT < 5.5 stented graft Brown, Gewillig ICC 2010
25 Growth of PA in PA-IVS Neonatal 1630 gr R/ 3.0 mm Laks shunt At 4m 4.000g R/ stent expansion 4.0 mm At 8m R/ Glenn
26 HLHS, 3 years pre-fontan Status PO Norwood 3.0 central shunt; PO Glenn Courtesy Y d Udekem
27 EB, HLHS, 3 years pre-fontan 6 mm GT mbt shunt, clip on central PA Courtesy Y d Udekem
28 EB 1 year post-fontan Le PA reconstructed with 12 GT Courtesy Y d Udekem
29 The Fontan circulation The Fontan circuit after completion runs on autopilot ; it allows very little modulation Management of failure: Better to stay out of trouble Then to get out of trouble Excell in getting optimal building blocks Optimal ventricle Optimal pulmonary circulation requirements volume load : divergent!!! current strategies overprotect the ventricle & neglect growth of PA s
30
31 Martinique 2015 Session Fontan Circulations de Fontan: un equilibre précaire? Marc Gewillig, MD, PhD Louvain, Belgique
Pulmonary vasodilators in Fontan Patients
Pulmonary vasodilators in Fontan Patients Maurice Beghetti Pediatric Cardiology University Children s Hospital HUG and CHUV Pulmonary Hypertension Program HUG Centre Universitaire Romand de Cardiologie
Failure of the Fontan Circulation
Failure of the Circulation Marc Gewillig, MD, PhD a, *, David J. Goldberg, MD b KEYWORDS circulation Chronic low output Circulatory failure Pulmonary vascular resistance KEY POINTS The essence of a circuit
The Fontan circulation. Folkert Meijboom
The Fontan circulation Folkert Meijboom What to expect? Why a Fontan-circulation Indications How does it work Types of Fontan circulation Historical overview Role of echocardiography What to expect? Why
Foetal Cardiology: How to predict perinatal problems. Prof. I.Witters Prof.M.Gewillig UZ Leuven
Foetal Cardiology: How to predict perinatal problems Prof. I.Witters Prof.M.Gewillig UZ Leuven Cardiopathies Incidence : 8-12 / 1000 births ( 1% ) Most frequent - Ventricle Septum Defect 20% - Atrium Septum
Evolutionary origins of the right ventricle. S Magder Department of Critical Care, McGill University Health Centre
Evolutionary origins of the right ventricle S Magder Department of Critical Care, McGill University Health Centre Fully separated four chamber heart only evolved in birds and mammals What are the evolutionary
Pathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
Pulmonary Hypertension in 2012
Pulmonary Hypertension in 2012 Evan Brittain, MD December 7, 2012 Kingston, Jamaica VanderbiltHeart.com Disclosures None VanderbiltHeart.com Outline Definition and Classification of PH Hemodynamics of
The Fontan operation. Choussat s 10 commandments revisited. Early palliative approach: systemic to pulmonary shunt or banding
Echographic assessment in Fontan patients: sequential segmental approach Functionnaly Single Ventricle Glenn and Fontan echocardiographic assessment Xavier Iriart 1. Cavopulmonary connection 2. Branch
Pulmonary Hypertension Perioperative Management
Pulmonary Hypertension Perioperative Management Bruce J Leone, MD Professor of Anesthesiology Chief, Neuroanesthesiology Vice Chair for Academic Affairs Mayo Clinic Jacksonville, Florida Introduction Definition
Glenn Shunts Revisited
Glenn Shunts Revisited What is a Super Glenn Patricia O Brien, MSN, CPNP-AC Nurse Practitioner, Pediatric Cardiology No Disclosures Single Ventricle Anatomy Glenn Shunt Cavopulmonary Anastomosis Anastomosis
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal. Drugs for the treatment of pulmonary arterial hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Drugs for the treatment of Draft remit / appraisal objective: Draft scope To appraise the clinical and cost effectiveness
GIGA - In Silico Medicine, University of Liege, Belgium, 2
S. Kosta 1,*, A. Pironet 1, J.A. Negroni 2, E.C. Lascano 2, P.C. Dauby 1 1 GIGA - In Silico Medicine, University of Liege, Belgium, 2 Department of Comparative Cellular and Molecular Biology, Favaloro
FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART
FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART CINDY BITHER, MSN, ANP, ANP, AACC, CHFN CHIEF NP, ADV HF PROGRAM MEDSTAR WASHINGTON HOSPITAL CENTER CONFLICTS OF INTEREST NONE
Pathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
Surgical Management of Lymphatic Complications After Univentricular Heart Repair
Surgical Management of Lymphatic Complications After Univentricular Heart Repair Christian Kreutzer MD Head, Pediatric and congenital Heart Surgery Hospital Universitario Austral. Buenos Aires. Argentina
Pulmonary Hypertension: Another Use for Viagra
Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A
Pulmonary Hypertension. Murali Chakinala, M.D. Washington University School of Medicine
Pulmonary Hypertension Murali Chakinala, M.D. Washington University School of Medicine Pulmonary Circulation Alveolar Capillary relationship Pulmonary Circulation High flow, low resistance PVR ~1/15 of
Cardiac Emergencies in Infants. Michael Luceri, DO
Cardiac Emergencies in Infants Michael Luceri, DO October 7, 2017 I have no financial obligations or conflicts of interest to disclose. Objectives Understand the scope of congenital heart disease Recognize
Outline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease
Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline
The Single Ventricle. Karim Rafaat, M.D.
The Single Ventricle Karim Rafaat, M.D. The title single ventricle includes those lesions designated as both HLHS HRHS HLHS is far more common, and the strategy for palliation of both lesions similar,
Survival Rates of Children with Congenital Heart Disease continue to improve.
DOROTHY RADFORD Survival Rates of Children with Congenital Heart Disease continue to improve. 1940-20% 1960-40% 1980-70% 2010->90% Percentage of children with CHD reaching age of 18 years 1938 First Patent
The right heart: the Cinderella of heart failure
The right heart: the Cinderella of heart failure Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland none Disclosure Look into the Heart
Topics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow
Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac
Nothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
RV dysfunction and failure PATHOPHYSIOLOGY. Adam Torbicki MD, Dept Chest Medicine Institute of Tuberculosis and Lung Diseases Warszawa, Poland
RV dysfunction and failure PATHOPHYSIOLOGY Adam Torbicki MD, Dept Chest Medicine Institute of Tuberculosis and Lung Diseases Warszawa, Poland Normal Right Ventricle (RV) Thinner wall Weaker myocytes Differences
PULMONARY HYPERTENSION & THALASSAEMIA
3rd Pan-American Thalassaemia Conference Buenos Aires 2010 Dr Malcolm Walker Cardiologist University College & the Heart Hospital LONDON Clinical Director Hatter Cardiovascular Institute - UCLH PULMONARY
Hypertension in Aortic Valve Disease
Hypertension in Aortic Valve Disease Hanna M. Nosseir MRCP, FRCP Head of Cardiology department Galaa Military Medical Complex Aortic stenosis: Introduction Arterial hypertension and aortic stenosis are
MRI and ce-mra in patients who have undergone a Fontan operation or a Bidirectional Cavo-Pulmonary Connection for Single Ventricle physiology
MRI and ce-mra in patients who have undergone a Fontan operation or a Bidirectional Cavo-Pulmonary Connection for Single Ventricle physiology R.Crepaz, J.Stuefer*, C.Romeo, C.Pedron **, O.Milanesi ^, G.
CMR for Congenital Heart Disease
CMR for Congenital Heart Disease * Second-line tool after TTE * Strengths of CMR : tissue characterisation, comprehensive access and coverage, relatively accurate measurements of biventricular function/
Hybrid Therapy for Hypoplastic Left Heart Syndrome Myth, Alternative or Standard?
Hybrid Therapy for Hypoplastic Left Heart Syndrome Myth, Alternative or Standard? Can Yerebakan, Klaus Valeske, Hatem Elmontaser, Matthias Mueller, Juergen Bauer, Josef Thul, Dietmar Schranz, Hakan Akintuerk
The Physiology of the Fetal Cardiovascular System
The Physiology of the Fetal Cardiovascular System Jeff Vergales, MD, MS Department of Pediatrics Division of Pediatric Cardiology jvergales@virginia.edu Disclosures I serve as the medical director for
Cardiac Output (C.O.) Regulation of Cardiac Output
Cardiac Output (C.O.) Is the volume of the blood pumped by each ventricle per minute (5 Litre) Stroke volume: Is the volume of the blood pumped by each ventricle per beat. Stroke volume = End diastolic
Role of pulmonary vasodilators in the Fontan setting. Michael Cheung Melbourne
Role of pulmonary vasodilators in the Fontan setting Michael Cheung Melbourne Fontan circuit Low resistance to adequate pulmonary blood flow is critical Central PA anatomy (size and distortion) Intrapulmonary
Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
Ventricular-Pulmonary Vascular Coupling after the Total Cavopulmonary Anastomosis (Fontan)
Ventricular-Pulmonary Vascular Coupling after the Total Cavopulmonary Anastomosis (Fontan) 6th International Neonatal & Childhood Pulmonary Vascular Disease Conference Fontan Physiology Single ventricular
Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
Καθετηριασμός δεξιάς κοιλίας. Σ. Χατζημιλτιάδης Καθηγητής Καρδιολογίας ΑΠΘ
Καθετηριασμός δεξιάς κοιλίας Σ. Χατζημιλτιάδης Καθηγητής Καρδιολογίας ΑΠΘ The increasing interest in pulmonary arterial hypertension (PAH), the increasing interest in implantation of LVADs, and the evolution
Recent Treatment of Pulmonary Artery Hypertension. Cardiology Division Yonsei University College of Medicine
Recent Treatment of Pulmonary Artery Hypertension Cardiology Division Yonsei University College of Medicine Definition Raised Pulmonary arterial pressure (PAP) WHO criteria : spap>40 mmhg NIH Criteria
Management of Heart Failure in Adult with Congenital Heart Disease
Management of Heart Failure in Adult with Congenital Heart Disease Ahmed Krimly Interventional and ACHD consultant King Faisal Cardiac Center National Guard Jeddah Background 0.4% of adults have some form
Introduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
Glenn and Fontan Caths:
Glenn and Fontan Caths: Pre-operative evaluation and Trouble-shooting Cavo-Pulmonary Shunts Daniel H. Gruenstein, M.D. Director, Pediatric Interventional Cardiology University of Minnesota Children s Hospital,
Chapter 21. Blood Vessels and Circulation
Chapter 21 Openstax: Chapter 20 Blood Vessels and Circulation Chapter 21 Learning Outcomes After completing Chapter 21, you will be able to: 1. Distinguish among the types of blood vessels based on their
Calculations the Cardiac Cath Lab. Thank You to: Lynn Jones RN, RCIS, FSICP Jeff Davis RCIS, FSICP Wes Todd, RCIS CardioVillage.
Calculations the Cardiac Cath Lab Thank You to: Lynn Jones RN, RCIS, FSICP Jeff Davis RCIS, FSICP Wes Todd, RCIS CardioVillage.com Disclosure Information Calculations the Cardiac Cath Lab Darren Powell,
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH Javier Jimenez MD PhD FACC Director, Advanced Heart Failure and Pulmonary Hypertension Miami Cardiac & Vascular Institute
Hybrid Stage I Palliation / Bilateral PAB
Hybrid Stage I Palliation / Bilateral PAB Jeong-Jun Park Dept. of Thoracic & Cardiovascular Surgery Asan Medical Center, University of Ulsan CASE 1 week old neonate with HLHS GA 38 weeks Birth weight 3.0Kg
Pre-discussion questions
Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define
Congestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption
Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty
가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY
가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY PA c IVS (not only pulmonary valve disease) Edwards JE. Pathologic Alteration of the right heart. In: Konstam MA, Isner M, eds.
Objective 2/9/2012. Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. VENOARTERIAL CO2 GRADIENT
Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. Gary Grist RN CCP Chief Perfusionist The Children s Mercy Hospitals and Clinics Kansas City, Mo. Objective The participant
Failing right ventricle
Failing right ventricle U. Herberg 1, U. Gembruch 2 1 Pediatric Cardiology, 2 Prenatal Diagnostics and Fetal Therapy, University of Bonn, Germany Prenatal Physiology Right ventricle dominant ventricle
Cardiac Output MCQ. Professor of Cardiovascular Physiology. Cairo University 2007
Cardiac Output MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 90- Guided by Ohm's law when : a- Cardiac output = 5.6 L/min. b- Systolic and diastolic BP
Use of the Total Artificial Heart in the Failing Fontan Circulation J William Gaynor, M.D.
Use of the Total Artificial Heart in the Failing Fontan Circulation J William Gaynor, M.D. Daniel M. Tabas Endowed Chair in Pediatric Cardiothoracic Surgery at The Children s Hospital of Philadelphia The
Hemodynamics: Cardiac and Vascular Jeff Davis, RRT, RCIS
Hemodynamics: Cardiac and Vascular Jeff Davis, RRT, RCIS Program Director, Cardiovascular Technology Florida SouthWestern State College Fort Myers, FL Disclosures Speaker s Bureau: None Stockholder: None
MANAGEMENT OF LATE PRESENTATION OF CONGENITAL HEART DESEASE
MANAGEMENT OF LATE PRESENTATION OF CONGENITAL HEART DESEASE Guillermo E. Moreno Pediatric Cardiac Intensive Care Unit (UCI35) Hospital de Pediatría Dr. Juan P. Garrahan Buenos Aires - Argentina Non financial
Critical Heart Disease in the Newborn. What you need to know
Critical Heart Disease in the Newborn What you need to know DISCLOSURES Nothing to report OBJECTIVES DESCRIBE NEONATAL CARDIOVASCULAR PHYSIOLOGY RECOGNIZE NEONATAL CARDIAC EMERGENCIES FORMULATE TREATMENT
ino in neonates with cardiac disorders
ino in neonates with cardiac disorders Duncan Macrae Paediatric Critical Care Terminology PAP Pulmonary artery pressure PVR Pulmonary vascular resistance PHT Pulmonary hypertension - PAP > 25, PVR >3,
Pulmonary circulation. Lung Blood supply : lungs have a unique blood supply system :
Dr. Ali Naji Pulmonary circulation Lung Blood supply : lungs have a unique blood supply system : 1. Pulmonary circulation 2. Bronchial circulation 1- Pulmonary circulation : receives the whole cardiac
Physiologic Based Management of Circulatory Shock Kuwait 2018
Physiologic Based Management of Circulatory Shock Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal Echocardiography, Point of Care and Hemodynamics Program Staff Neonatologist
Heart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)
Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types
Heart Pump and Cardiac Cycle. Faisal I. Mohammed, MD, PhD
Heart Pump and Cardiac Cycle Faisal I. Mohammed, MD, PhD 1 Objectives To understand the volume, mechanical, pressure and electrical changes during the cardiac cycle To understand the inter-relationship
5/30/2014. Pulmonary Hypertension PULMONARY HYPERTENSION. mean PAP > 25 mmhg at rest. Disclosure: none
Disclosure: Pulmonary Hypertension none James Ramsay MD Medical Director, CV ICU, Moffitt Hospital, UCSF PULMONARY HYPERTENSION mean PAP > 25 mmhg at rest Pulmonary Hypertension and Right Ventricular Dysfunction:
What is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University
What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation
Neonatal and Pediatric Pulmonary Vascular Disease
Neonatal and Pediatric Pulmonary Vascular Disease Emma Olson, MS, ARNP Pediatric Cardiology Nurse Practitioner Canadian Respiratory Conference April 14, 2018 Financial Interest Disclosure (over the past
Haemodynamics. Milan Chovanec Department of Physiology 2.LF UK
Haemodynamics Milan Chovanec Department of Physiology 2.LF UK Major types of blood vessels Blood flow: 50cm/s 0.05cm/s Flow, pressure, resistance Flow, pressure, resistance ΔU = I x R Blood and vessels
From PV loop to Starling curve. S Magder Division of Critical Care, McGill University Health Centre
From PV loop to Starling curve S Magder Division of Critical Care, McGill University Health Centre Otto Frank 1890 s Frank-Starling Relationship ( The Law of the Heart ) The greater the initial stretch
Disclosures. Objectives 6/16/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension
A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension Susan P. D Anna MSN, APN-BC, CHFN June 24, 2016 Disclosures Objectives Differentiate structure and function of RV and LV
Heart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
Blood Volume: Vascular and Systemic
Various examples and supplementary slides that may be used in lecture. These are provided as a resource for M1 students by Dr. HN Mayrovitz Fall 2005. Note that all of the following slides may or may not
ADVANCED THERAPIES FOR PHARMACOLOGICAL TREATMENT OF PULMONARY HYPERTENSION
Status Active Medical and Behavioral Health Policy Section: Medicine Policy Number: II-107 Effective Date: 04/21/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
Outline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies
Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the
Pulmonic Ventricular Dysfunction Adult with Congenital Heart Disease
Pulmonic Ventricular Dysfunction Adult with Congenital Heart Disease Louise Callow, RN, MSN, CPNP Pediatric Cardiac Surgery Nurse Practitioner University of Michigan, CS Mott Children s Hospital Ann Arbor,
Cardiac CT in Infants with Congenital heart disease Sunrise Session. LaDonna Malone, MD May 17, 2018
Cardiac CT in Infants with Congenital heart disease Sunrise Session LaDonna Malone, MD May 17, 2018 None Disclosures Objectives Describe cardiac CT techniques used in infants with congenital heart disease.
CMR EVALUATION OF AORTO- PULMONARY COLLATERALS PRIOR TO FONTAN AND THEIR IMPACT ON EARLY OUTCOME
XLIII CONGRESSO NAZIONALE SOCIETÀ ITALIANA DI CARDIOLOGIA PEDIATRICA Padova 16-19 Ottobre 2013 L.Ait-Ali, L. Arcieri, V. Pak, R. Moschetti, P. Festa. Istiituto di fisiologia clinica CNR Massa U.O. Cardiologia
Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation?
Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling What is the pathophysiology at presentation? Ventricular-arterial coupling elastance Central arterial pressure
The Challenging Pediatric Cardiac Patient. Edmund Jooste
The Challenging Pediatric Cardiac Patient Edmund Jooste A 5 -year old female with hypoplastic left heart syndrome s/p the Fontan procedure presents for laparoscopic appendectomy for acute appendicitis.
Review Article. Interactive Physiology in Critical Illness : Pulmonary and Cardiovascular Systems. Introduction
310 Indian Deepak J Physiol Shrivastava Pharmacol 2016; 60(4) : 310 314 Indian J Physiol Pharmacol 2016; 60(4) Review Article Interactive Physiology in Critical Illness : Pulmonary and Cardiovascular Systems
The Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities
The Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
Cardiac output and Venous Return. Faisal I. Mohammed, MD, PhD
Cardiac output and Venous Return Faisal I. Mohammed, MD, PhD 1 Objectives Define cardiac output and venous return Describe the methods of measurement of CO Outline the factors that regulate cardiac output
Congenital Heart Disease
Congenital Heart Disease Mohammed Alghamdi, MD, FRCPC, FAAP, FACC Associate Professor and Consultant Pediatric Cardiology, Cardiac Science King Fahad Cardiac Centre King Saud University INTRODUCTION CHD
When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영
When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 The Korean Society of Cardiology COI Disclosure Eun-Young Choi The author have no financial conflicts of interest to disclose
5.8 Congenital Heart Disease
5.8 Congenital Heart Disease Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. Some of these lesions may be discovered later. prevalence of Chd
2010 년순환기관련학회춘계통합학술대회. Kim, Soo-Jin. Sejong General Hospital, Sejong Cardiovascular center
2010 년순환기관련학회춘계통합학술대회 세종병원 Sejong General Hospital Debate in Congenital Heart Disease : Pulmonary Vasodilator in Fontan Kim, Soo-Jin Sejong General Hospital, Sejong Cardiovascular center 12 yrs, s/p Fontan
Pathophysiology: Heart Failure
Pathophysiology: Heart Failure Mat Maurer, MD Irving Assistant Professor of Medicine Outline Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology Heart Failure: Definitions
Fontan Deterioration in Pediatric Cardiologist s s View. Pusan National University Hospital Hyoung Doo Lee M.D.
Fontan Deterioration in Pediatric Cardiologist s s View Pusan National University Hospital Hyoung Doo Lee M.D. Outcomes of Fontan operation JTCS 2006:131;172-80 Mitchell ME et al Jan. 1992~Dec. 1999, 332
Management of a Patient after the Bidirectional Glenn
Management of a Patient after the Bidirectional Glenn Melissa B. Jones MSN, APRN, CPNP-AC CICU Nurse Practitioner Children s National Health System Washington, DC No Disclosures Objectives qbriefly describe
Principles of Biomedical Systems & Devices. Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont
Principles of Biomedical Systems & Devices Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont Review of Cardiac Anatomy Four chambers Two atria-receive blood from the vena cave and pulmonary veins Two
Advanced imaging of the left atrium - strain, CT, 3D, MRI -
Advanced imaging of the left atrium - strain, CT, 3D, MRI - Monica Rosca, MD Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Declaration of interest: I have nothing to declare Case
I intend to discuss an unapproved/investigative use of a commercial product/device in my presentation
Istvan Seri MD PhD Center for Fetal and Neonatal Medicine USC Division of Neonatal Medicine Children Hospital Los Angeles and LAC+USC Medical Center Keck School of Medicine University of Southern California
Pulmonary hypertension and right ventricular failure
Pulmonary hypertension and right ventricular failure Sven-Erik Ricksten Dept. Anaesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg,
Blood Flow, Blood Pressure, Cardiac Output. Blood Vessels
Blood Flow, Blood Pressure, Cardiac Output Blood Vessels Blood Vessels Made of smooth muscle, elastic and fibrous connective tissue Cells are not electrically coupled Blood Vessels Arteries arterioles
Maternal and Fetal Physiology
Background Maternal and Fetal Physiology Anderson Lo, DO Fellow, Maternal-Fetal Medicine Wayne State University School of Medicine SEMCME Fetal Assessment Course July 20, 2018 Oxygen pathway Mother Placenta
Surgical Management of Failing Fontan Operation
Surgical Management of Failing Fontan Operation Jeong-Jun Park Dept. of Thoracic & cardiovascular Surgery Asan Medical Center, Ulsan University Fontan operation 1995-2001, 123 procedures in 71 pts EJCTS
More History. Organization. Maternal Cardiac Disease: a historical perspective. The Parturient with Cardiac Disease 9/21/2012
The Parturient with Cardiac Disease Pamela Flood M.D. Professor of Anesthesia and Perioperative Care Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Maternal Cardiac
Paediatric Cardiology. Acyanotic CHD. Prof F F Takawira
Paediatric Cardiology Acyanotic CHD Prof F F Takawira Aetiology Chromosomal Down syndrome, T13, T18 Genetic syndromes (gene defects) Velo-Cardio-facial (22 del) Genetic syndromes (undefined aetiology)
Preoperative Echocardiographic Assessment of Uni-ventricular Repair
Preoperative Echocardiographic Assessment of Uni-ventricular Repair Salem Deraz, MD Pediatric Cardiologist, Aswan Heart Centre Magdi Yacoub Heart Foundation Uni-ventricular repair A single or series of
QUIZ 1. Tuesday, March 2, 2004
Harvard-MIT Division of Health Sciences and Technology HST.542J: Quantitative Physiology: Organ Transport Systems Instructors: Roger Mark and Jose Venegas MASSACHUSETTS INSTITUTE OF TECHNOLOGY Departments
Age-related changes in cardiovascular system. Dr. Rehab Gwada
Age-related changes in cardiovascular system Dr. Rehab Gwada Objectives explain the main structural and functional changes in cardiovascular system associated with normal aging Introduction aging results
Teaching Round Claudio Sartori
Teaching Round 14.03.2017 Claudio Sartori Cas clinique Femme 47 ans, connue pour un BPCO, asthénie, douleurs thoraciques, dyspnée à l effort, œdèmes membres inférieurs, deux syncopes. Tabac, BMI 31 kg/m2
Recruitment of pre-existing vessels. versus. Angiogenesis
Pulmonary Arteriovenous Malformations After the Bidirectional Glenn and the Role of VEGF Background PAVMs first recognised during follow-up after classical Glenn shunt, in ipsilateral lung N.Sreeram. Heart