VSD PAH CATH MEET

1. CATH MEET
28/06/2018
MURTAZA KAMAL
FELLOW PEDIATRIC CARDIOLOGY
murtaza.vmmc@gmail.com
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2. HISTORY
11 years old male child
Diagnosed to have a heart disease at the age of 6
months when he had h/o breathing difficulty
Symptoms improved after medications
One more episode of LRTI at 13 months of age
No H/o feeding difficulty, cyanotic spells , pedal
edema.
H/o failure to thrive
Born out of non consanguineous marriage, no other
member in the family having a HD
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3. EXAMINATION
GPE: wt-16kg , ht-120cm, BMI: 11.1 kg/m2 with some
pallor, No cyanosis, jaundice, clubbing, lymphadenopathy,
pedal oedema
Vitals : B.P-110/70 mmhg ,Pulse-98/mt regular normal
volume & character no RR or RF delay , RR-20/mt ,
afebrile. JVP: Not raised
CVS:
Apex: RV type, diffuse, Grade 1/3 parasternal haeve
+nt, epigastric pulsations +nt
S1-N ; S2- Loud P2; no additional sounds;
3/6 pan systolic murmur most prominent in 3rd
and 4th
Lt ICS, high pitched , no variation with respiration
No other murmur
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4. ECG
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5. CXR
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6. Situs solitus , Levocardia, Normal systemic and pulmonary
venous drainage, AV –VA concordance, NRGA
Intact IAS
Large perimembranous VSD with B/D shunt (mostly lt rt) with
IV gradient 24 mm Hg
No PDA
LA, LV are dilated, Normal right sided chambers
Mild TR with RVSP of 90 mm Hg, No AR , PR , MR
No associated PDA,COA , ASD , RVOT obs
Good biventricular function
2D - ECHO
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7. CATHETERISATION
11 years old male child
Ht-120 cm, wt-16 kg , BMI- 13.29Kg/mt2, BSA- 0.66 mt2
Hb-8.8 gm/dl,
HR- 115/min, SpO2-100% (RA)
O2 con-151 ml/min/mt2
INDICATION: - ASSESSMENT OF PA PRESSURE
AND REVERSIBILITY OF THE SHUNT
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8. CATHETERISATION
Under general anesthesia
All aseptic precautions
Vascular access obtained with Seldinger technique
100IU/Kg heparin
Catheter course:
Rt FV---IVC---RA--- RV--- PA---PCW
Rt FA---AO---LV
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9. CONDITION-1 DATA
Pressure
AORTA 122/53/75
FA 116/54/74
PCWP 12
PA 86/46/64
RV 84/10
RA 9/2/5
LV 90/10
CHAMB
ER
PO2 SPO2
IVC 44.1 57.7
SVC 49.3 73.4
RA 47 67.2
RV 63.7 88.4
PA 57.3 83.2
LV 102 97.1
FA 103 97.1 9

10. FEmORAl ARTERy
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11. PA+AORTA SImUlTANEOUS
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12. PCWP
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13. RA
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14. LEFT VENTRICLE
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15. LV+RV SIMULTANEOUS
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16. LETS REVISE ThE FORMULAE
• Qp (L/min) =02 consumption (VO2)/ (PV O2
content- PA O2 content)
• Qs (L/min) = O2 consumption (V02)/ (SA 02
content- MVO2 content)
• PVR=Mean PA pressure- Mean LA pressure/ Qp
• SVR= MeanAo pressure- Mean RA pressure/ Qs
• PVRI= PVR* BSA
• SVRI=SVR* BSA
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17. • Qp = 151/13.6 * 8.8 * ( 1 - .83) = 7.4 L/mt
• Qs = 151/13.6 * 8.8 * (.97 - .69) = 4.5 L/mt
• Qp/Qs = 7.4/4.5 = 1.64
• PVR = 64-12/7.4 = 7.02 wood units
• SVR = 75-5/4.5 = 15.55 wood units
• PVRI = 7.02* 0.66 = 4.6
• SVRI = 15.55 * 0.66 = 10.26
• PVR/SVR = 7.02/15.45 = 0.45
CATHETERISATION DATA 1
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18. CONDITION-2 DATA
FA 88/60/75
PCWP 8
PA 76/33/56
RV 81/9
RA 9/2/5
LV 97/11
CHAMB
ER
PO2 SPO2
IVC 56.5 82.7
SVC 60.6 84.3
PA 201 99.2
LV 496 99.6
FA 465 99.6
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19. CATHETERISATION DATA 2
• Qp = 151/13.6 * 8.8 * ( .99 - .95) = 31.75 L/mt
• Qs = 151/13.6 * 8.8 * (.99 - .83) = 7.93 L/mt
• Qp/Qs = 31.75/7.93 = 4
• PVR = 56-8/31.75 = 1.51 wood units
• SVR = 75-5/7.93 = 8.82 wood units
• PVRI = 1.51 * 0.66 = 0.99
• SVRI = 8.82 * 0.66 = 5.82
• PVR/SVR = = 1.51/8.82 = 0.17
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20. ANALYSIS
• NORMAL SYSTEMIC PRESSURE
• NORMAL LV SYSTOLIC AND FILLING PRESSURE
• NO SIGNIFICANT GRADIENT ACROSS LV TO AORTA
• HIGH SYSTOLIC, DIASTOLIC AND MEAN PA
PRESSURES
• HIGH RV SYSTOLIC PRESSURE AND NORMAL FILLING
PRESSURE
• NO SIGNIFICANT GRADIENT FROM RV TO PA
• BOTH PVRi AND PVR/SVR RATIOS DECREASED IN
CONDITION 2
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21. ANGIOGRAMS
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22. ANGIOGRAMS
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23. ANGIOGRAMS
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24. THANK YOU
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