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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

HOW IMPORTANT


  • 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



40 mm hg post op gradient
40 Mm Hg POST- OP GRADIENT RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

  • IT WILL VARY WITH THE SQUARE OF THE OUTPUT. IF THE OUTPUT DOUBLES, THE GRADIENT WILL BECOME 160 mm Hg


Now what
NOW WHAT RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

  • 1. R/O A FALSE GRADIENT (BILEAFLET VALVES).

  • ASSESS VALVE FUNCTION

  • CATH IF NECESSARY


ECHO RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

  • 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 RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

NOW WHAT?


Evaluate as new case of as
EVALUATE as NEW CASE OF AS RE-INSTALLED THE SAME VALVE, WOULD HE BE ANY BETTER?

  • SYMPTOMS

  • EXERCISE

  • FUNCTION




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