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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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Ppm

PPM

HOW IMPORTANT


Ppm

  • THE WORLD IS FLAT

  • NO ONE REALLY LANDED ON THE MOON

  • OBSTRUCTION IN AS IS AN INNOCENT BYSTANDER


Ppm

BLAIS et al


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


Ppm

  • 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


Ppm

ECHO

  • PV MOVEMENT NL

  • JET 3.1 m/sec

  • AVA 0.9 cm2

  • EF 0.2


Given a large gradient does exist

GIVEN A LARGE GRADIENT DOES EXIST

NOW WHAT?


Evaluate as new case of as

EVALUATE as NEW CASE OF AS

  • SYMPTOMS

  • EXERCISE

  • FUNCTION


Ppm

  • TRIAL OF BETA BLOCKADE


Ppm

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


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