Swan Song: Echocardiography as a Pulmonary Artery Catheter? Interdepartmental Division of Critical Care Medicine
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1 Swan Song: Echocardiography as a Pulmonary Artery Catheter?
2 The swan is without spot, and it sings sweetly as it dies, that song ending its life Leonardo Da Vinci
3 Curr Opin Anesthesiol 2016, 29:36 45 Circulation. 2015;131: Journal of Critical Care 29 (2014) 184.e1 184.e8
4 Temporelli, Circ Heart Fail. 2010;3:
5 Temporelli, Circ Heart Fail. 2010;3:
6 Pressure Waveforms in the Right Heart and Pulmonary Artery. Kelly CR, Rabbani LE. N Engl J Med 2013;369:e35.
7 LIVER LIVER IVC RA IVC RA Ruddski, J Am Soc Echocardiogr 2010;23:
8 RV RA LV LA J Am Soc Echocardiogr 2013;26:
9 J Am Soc Echocardiogr 2013;26:
10 E/Ea > 6 = RAP >10 mmhg Se 79% and Sp 73% Nageh The american Journal of Cardiology, Vol 84; 1999
11 Acceleration rate of E wave Rate > 560 cm/s 2 predicted a RAP > 5mmHg (Se 100% and Sp 99%) Independent predictor of RAP Am Jour of Cardiology 1998
12 RAP = 1.62 E/E J Am Soc Echocardiogr 2007;20:
13 Pressure Waveforms in the Right Heart and Pulmonary Artery. Kelly CR, Rabbani LE. N Engl J Med 2013;369:e35.
14 Circulation 70, No 4, , 1984
15 Yock, Circulation 70, No 4, , 1984
16 RA RV LA LV Apical 4 Chamber or RV modified RV inflow RV inflow/outflow Alignment with TR jet Estimation of RVSP. Continuous wave doppler TR jet velocity in m/s RVSP = 4 (TR) 2 + RAP Agitated saline
17 Soliman, Anaesthesia 2015; 70 : LA RA RV LA RA AV RV
18 Anesthesiology, V 108, No 1, Jan 2008
19
20 Schiller, JASE 2013
21 Rich, Chest 2013: 143 (6):
22 R= 0.7 (95% CI: ) Heart 2011;97:612e622.
23 Pressure Waveforms in the Right Heart and Pulmonary Artery. Kelly CR, Rabbani LE. N Engl J Med 2013;369:e35.
24 RA RV AV LA In absence of RVOT obstruction PV stenosis VSD Ao PA RVSP = PA systolic pressure
25 Jardin, Viellard Baron, Current Opinion in Critical Care 2005, 11:
26 Acceleration time Mean PA pressure = 79 (0,45x AT) if At <120 ms 90 (0.62 x AT) Dabestani, Am J Cardiol 1987:
27 RVOT PA Mean PAP = 4 (early PI vel) 2 + RAP Diastolic PAP = 4 (end PI vel) 2 + RAP Mean PA = 1/3 systolic PA pressure + 2/3 diastolic PA pressure Rudski, JASE 2010: 23:
28 Pressure Waveforms in the Right Heart and Pulmonary Artery. Kelly CR, Rabbani LE. N Engl J Med 2013;369:e35.
29 Circulation, 2000; 102: MV E/e 2.82
30 Ommen, Circulation, 2000; 102:
31 J Am Coll Cardiol 1997;30:
32 1. Not accurate in 1. Normal subjects (load dependency) 2. Heavy annular calcification 3. Mitral valve disease 4. Pericardial disease 2. Gray zone of values 3. Reduced accuracy in patients with CAD and regional dysfunction 4. Different cutoff values depending on the site used J Am Soc Echocardiogr 2016;29:
33 Pressure Waveforms in the Right Heart and Pulmonary Artery. Kelly CR, Rabbani LE. N Engl J Med 2013;369:e35.
34 Circulation. 1981;63: Circulation 1984; 70:
35 LV Ao LA CO = LVOT CSA x LVOT VTI x HR Stroke Volume Circulation 70, No. 3, , 1984
36 CO = LVOT CSA x LVOT VTI x HR Stroke Volume (Error) 2 Appropriate VTI Alignement Distance from the valve
37 Other Parameters Pulmonary vascular resistance Systemic vascular resistance LA pressure from Mitral Regurgitation LVEDP from Aortic Regurgitation
38 R = 0.42 Come, Am J Cardiol 1988; 61:
39 Final words Laënnec 1816, France Solomon,NEJM 2014, 370;
40 Public domain
41 Merci de votre attention
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