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30 TH Echo Club Meeting. DR : Fatema Qaddoura Consultant Cardiologist KFMMC. History. 55 year old F K/C of SC trait RHD, MVD- sever MR,CAD Pt underwent MV repair,2007 Regular F/U in OPD, pt. was asymptomatic, with clinical evaluations & Echo studies.

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30 th echo club meeting

30TH Echo Club Meeting

DR : Fatema Qaddoura

Consultant Cardiologist

KFMMC


History
History

  • 55 year old F

  • K/C of SC trait

  • RHD, MVD- sever MR,CAD

  • Pt underwent MV repair,2007

  • Regular F/U in OPD, pt. was asymptomatic, with clinical evaluations & Echo studies.

  • The Pt presented with progressive SOB over the last 2months NYHA class IV.


Hospital progress
Hospital progress

  • Found to have Hb of 6 g%

  • 2units of blood Tx. was given

  • Patient was completely asymptomatic


TTE

Moderate MR

Moderate plus TR with significant PHT

Is it 2ndary to

Pure MR or +/- SC trait




What to do next1
What to do next?

  • MVR

  • Invasive assessment of MR

  • TEE

  • Medical Rx. With diuretics and vasodilators



TEE

Moderate Sever MR



What to do next2
What to do next?

  • MVR

  • Invasive assessment of MR

  • Medical Rx. With diuretics and vasodilators


Invasive procedure
Invasive procedure

Pressure abnormalities Ventriculography

The classically taught hemodynamic abnormality of mitral regurgitation is the presence of a prominent v wave on the PCWP




Definition of prominent v wave
Definition of prominent v wave

  • peak v wave in excess of 40 mmHg,

  • a difference between the peak v wave and mean PCWP >10 mmHg or

  • the ratio of the peak v wave to mean PCWP >2

  • v wave height three times the mean PCWP is virtually diagnostic of severe, acute mitral regurgitation.


Left ventriculograms
Left Ventriculograms




Final dx
Final Dx.

Moderate sever MR

Moderate TR, sever PHT with dilated RV

Sickle cell Trait

Multifactorial PHT


Final plan
Final plan

For MVR and TV repair


In summery :

  • Step by step evaluation

  • Use all modalities to reach your conclusion

  • Share with your team

  • At the end you did your part and hope your decision was the best choice for the patient



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