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7/27/2019 Shunt calculation, NICVD
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Shunt calculation
Dr Mohammad Ullah FirozeASSISTANT PROFESSOR
NICVD
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History
Werner Forssmann- 1929.
By the early 1940s angiography in CHD was well
established
Methodology and techniques was standardized in 1940s by
Cournand.
In the 1950s and 1960s with development of surgical
techniques, refinement and development of cardiac
catheterization was done.
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WERNER FORSSMANN
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PRINCIPLE
Identify the shunt.
Complications of shunt.
Associated lesions.
Operability.
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Precatheterization assessment
It should be goal oriented and be planned to findout the patients problem and to set the
background for future therapeutic maneuvers.
History
Physical examination
ECG
CXR
ECHO
Hb%.
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Approaches in cardiac cath
Oxymetry.
Trajectory.
Graphy.
Pressure measurement.
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Shunt calculation
Echo-
Qp/Qs
Catheterization
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Catheterization
Catheters-
a) Cournand
b) NIH
c) Multipurpose
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Oxymetry
The general rule get whatever information youcan while you are there; you may never be back.
Collect the blood samples in 7 min.
Use end hole catheter first for oxymetry and
pressure measurement , then angiography by
NIH. Start from PA-RV-RA-LA-PV-SVC-IVC-Syst.Art.
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Site Average Range
SVC 74% 67-83%
IVC 78% 65-87
RA 75 65-87
RV 75 67-84
PA 75 67-84
LA,LV,SYST. ART. 95 92-98
Normal oxygen saturations
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OXYMETRIC DETECTION OF INTRACARDIACSHUNTS
Cardiac chambersampled
% Increase OrDecrease
SVC & RA 7%
RA & RV 5
RV & PA 3
LA or PV & LV orartery
-3
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Formula for calculating blood flow
Qp=VO2/(PVsat-PAsat)(o2capacity)
Qs=VO2/(SAsat-MVsat)(o2capacity)
Qep= VO2/(PVsat-MVsat)(o2capacity)
L-R shunt=Qp-Qep
R-L shunt=Qs- Qep
Net shunt=(L-R shunt)- (R-L shunt)
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L-R shunt
PA86%
PV96%
MV76%
SA96%
Qep=2.5Qep=2.5
L-R=2.5
Qs=2.5
Qp=5.0
O2 carrying capacity=176.8
VO2=88.4
lungs
Syst. circ
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R-L shunt
PA70%
PV95%
MV70%
SA85%
Qp=2.0
Qep=2.0
Qs=3.3
Qep=2.0R-L=1.3
lungs
Syst. circ
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Bidirectional Shunt
PA86%
PV97%
SVC66%
Ao90%
Qs=2.1
Qp=4.5
L-R=2.9
R-L=0.5
Qep=1.6Qep=1.6
lungs
Syst. circ
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RESISTANCE
TPR=(PAp-PVp)/Qp
TSR=(AOp-RAp)/Qs
Unit of resistance= Hybrid resistance unit or Wood unit
Normal TSR= (9-12) infant,
(13-18) adult
Normal TPR=
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Importance of Resistance
TPR 0.7 surgery will
increase mortality or there will be no
reduction of pulm HTN.
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Reversibility of Pulm HTN
100% O2 for 10 min.
Inhalation Nitrate
I/V Prostaglandin
I/V Epinephrine
I/V Adenosine.
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High O2 Saturation in RA
ASD.
PAPVD. TAPVD.
VSD with TR
Garbodes defect.
Rupture sinus of Valsalva.
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VSD.
PDA with PR.
Coronary AV fistula.
Rupture sinus of Valsalva.
High O2 Saturation in RV
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PDA.
AP window.
High O2 Saturation in PA
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ASD
OXYGN SATURATION IN RA
CATHETER TRAJECTORY.
PRESSURE MPA. PVR.
PA GRAPHY WITH LEVOPHASE.
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ASD PRIMUM
OXYGN SATURATION IN RA
CATHETER TRAJECTORY.
PRESSURE MPA. PVR.
PA GRAPHY WITH LEVOPHASE.
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ASD SINUS VENOSUS
OXYGN SATURATION IN RA
CATHETER TRAJECTORY.
PRESSURE MPA. PVR.
PA GRAPHY WITH LEVOPHASE.
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PAPVD
OXYGN SATURATION IN RA
CATHETER TRAJECTORY.
PA GRAPHY WITH
LEVOPHASE.
PRESSURE MPA. PVR.
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VSD
OXYGN SATURATION IN RV .
LV GRAPHY.
PRESSURE MPA. PVR.
CATHETER TRAJECTORY.
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PDA
OXYGN SATURATION IN MPA .
CATHETER TRAJECTORY-
HAIRPIN APPEARANCE
ARCH AORTOGRAPHY.
PRESSURE MPA. PVR.
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TOF
RV Graphy.
LV graphy.
Root aortography.
Arch aortography
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COARC. AORTA
PRESSURE GRADIENT.
AORTOGRAPHY
- NARROW AORTA.
- COLLATERAL
CIRCULATION.
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