Precision medicine in Adult with Shunt

2019/09/16 22:22:15
Precision medicine in Adult with Shunt

Take home messages in “Echocardiogram”

1. Missed ASD
- RV volume load vs pressure load.
- Enlarged and high flow in MPA.
- Intact intertrial septum from conventional transthoracic echocardiogram does not exclude an ASD.
- Transesophageal echoicardiogram for SVC type and PAPVR.
- SAX/modified A4C tilt inferiorly for CS/IVC type.
- Back to basic skill – good physical exam and CXR reading.
2. ASD in the setting of high LV filling pressure
- LV non-compliance(HTHD, DCM, RCM, CP)
- Lutembacher(ASD + MS)
- Stiff LA syndrome
3. ASD closure in the setting of high LV filling pressure
à Further increase in LA pressure(blood from restrictive and high pressure LA can no longer decompress in to RA)
➔ Clinical worsening


Take home messages in “RHC: make it precisely”

1. New definition of pulmonary hypertension : mPAP 20 mmHg
2. Definitin of PAH
- mPAP > 20 mmHg
- PAWP < 15 mmHg
- PVR > 3 WU(240 dynes)
3. Potential misclassifications between pre- and post-capillary pulmonary hypertension depending on the method of PAWP reading
4. Predictor of mortality
- PAH-small defect
- mRAP > 15 mmHg
- Baseline PVRi > 8 WUm2
- Final PVRi > 8 WUm2 post AVT
5. Changing indication for right heart catheterization : RVOT sizing