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PPM. HOW IMPORTANT. THE WORLD IS FLAT NO ONE REALLY LANDED ON THE MOON OBSTRUCTION IN AS IS AN INNOCENT BYSTANDER. BLAIS et al. WHY THE CONTROVERSEY?. DEFINITION : AVA/BSA. VARIATION IN O2 CONSUMPTION. 65 TO 250 ml/min/M 2. GRADIENT.

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Presentation Transcript
slide1

PPM

HOW IMPORTANT

slide2

THE WORLD IS FLAT

  • NO ONE REALLY LANDED ON THE MOON
  • OBSTRUCTION IN AS IS AN INNOCENT BYSTANDER
why the controversey
WHY THE CONTROVERSEY?
  • DEFINITION : AVA/BSA
variation in o2 consumption
VARIATION IN O2 CONSUMPTION
  • 65 TO 250 ml/min/M2
gradient
GRADIENT
  • VARIES WITH THE SQUARE OF OUTPUT ( G = CO2 x AVA2)
as does not kill by magic
AS DOES NOT KILL BY MAGIC

IT’S THE OBSTRUCTION TO OUTFLOW STUPID

slide9

IF YOU REMOVED THE STENOTIC VALVE FROM A PATIENT AND RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

40 mm hg post op gradient
40 Mm Hg POST- OP GRADIENT
  • IT WILL VARY WITH THE SQUARE OF THE OUTPUT. IF THE OUTPUT DOUBLES, THE GRADIENT WILL BECOME 160 mm Hg
now what
NOW WHAT
  • 1. R/O A FALSE GRADIENT (BILEAFLET VALVES).
  • ASSESS VALVE FUNCTION
  • CATH IF NECESSARY
slide12
ECHO
  • PV MOVEMENT NL
  • JET 3.1 m/sec
  • AVA 0.9 cm2
  • EF 0.2
evaluate as new case of as
EVALUATE as NEW CASE OF AS
  • SYMPTOMS
  • EXERCISE
  • FUNCTION
slide17

NOW EVALUATE THE RISK OF A REDO WITH ROOT ENLARGEMENT OR A DIFFERENT VALVE

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