30TH 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. • The Pt presented with progressive SOB over the last 2months NYHA class IV.
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 next? • MVR • Invasive assessment of MR • TEE • Medical Rx. With diuretics and vasodilators
TEE Moderate Sever MR
What to do next? • MVR • Invasive assessment of MR • Medical Rx. With diuretics and vasodilators
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 • 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.
Final Dx. Moderate sever MR Moderate TR, sever PHT with dilated RV Sickle cell Trait Multifactorial PHT
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