![Page 1: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/1.jpg)
Disclosure:
Morton J. Kern, MD
Within the past 12 months, the presenter or their spouse/partner have had a financial interest/arrangement or affiliation with the organization listed below.
Company Name RelationshipRadi Medical Inc. Speakers BureauMerrit Medical Inc. ConsultantBracco Inc. Consultant
![Page 2: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/2.jpg)
LV hemodynamics
Morton J. Kern, MD
Associate Chief CardiologyDirector Clinical Affairs
University California IrvineOrange, California
![Page 3: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/3.jpg)
Common Hemodynamic Problems involving LV pressure measurements
LV Compliance AssessmentMitral StenosisLow Gradient Aortic StenosisHOCMProsthetic Valve DysfunctionDiastolic CHFConstriction v Restriction
![Page 4: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/4.jpg)
Potential Sources of Errors for Pressure Measurements
• Temporal delay of pressure transmission in fluid filled systems
• Nonsimultaneous pressure recordings
• Pressure damping
• Resonance artifact (underdamping)
• Calibration
• Flow dependence
• Effect of catheter across stenotic valve
Fusberg and Feldman T, Cath and CV Int 53:553;2001
![Page 5: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/5.jpg)
Techniques for Aortic Valve Gradient Measurement
• Single Catheter LV-Ao pullback
• LV and Femoral Sheath
• LV and Long aortic sheath
• Bilateral femoral access
• Double-lumen pigtail catheter
• Transeptal LV access with ascending Ao
• Pressure Guidewire with ascending Ao
• Multi-transducer micromanometer catheters
Fusberg and Feldman T, Cath and CV Int 53:553;2001
![Page 6: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/6.jpg)
BAMC Case #3117: Patient: 61 yo maleDx: 3V CAD filter: 50 Hz/ sample 250 Hz
Pre Contrast
Normal LV and Aortic Pressure, micromanometer transducers
Note normal impulse gradient
![Page 7: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/7.jpg)
FA + AO
FA + LV
Most Common Approach to LV-Ao Gradient measurement
![Page 8: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/8.jpg)
High Fidelity LV pressure can be measured with 0.014” pressure wire
Fusberg and Feldman T, Cath and CV Int 53:553;2001
![Page 9: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/9.jpg)
Parham and Kern, Cath and CV Int 53:553;2001
Retrograde hemodynamic Assessment of Prosthetic Valves with a Pressure Wire
![Page 10: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/10.jpg)
Damping and Resonance Artifacts
![Page 11: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/11.jpg)
Abnormal LV Diastolic Relaxation
![Page 12: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/12.jpg)
LV pressure changes with ValsavaManeuver
200mmHg
![Page 13: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/13.jpg)
LV/RV diastolic waveforms reflect differences in compliance, timing of activation and function
100mmHg
40mmHg
![Page 14: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/14.jpg)
LV/RV diastolic waveforms reflect differences in compliance, timing of activation and function
![Page 15: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/15.jpg)
LV Puncture for 2 prosthetic valves
Pigtail
AV
MV
Pigtail
![Page 16: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/16.jpg)
68yo W with 2 prosthetic valves
100mmHg
LVRV
![Page 17: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/17.jpg)
Abnormal LV diastolic relaxation?
![Page 18: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/18.jpg)
Abnormal LV diastolic relaxation?
![Page 19: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/19.jpg)
The LV pressure wave reflects the appropriate or inappropriate transmission of blood
What caused gradient to increase in beat #2?P wave
![Page 20: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/20.jpg)
What does the LV waveform tell us about this patient?
Wide PP, rapid diastolic upslope=AI Coarctation
200
![Page 21: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/21.jpg)
Coarctation of Aorta
Rib Notching
![Page 22: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/22.jpg)
Aortic Stenosis?
Aortic Regurgitation?
Wide Pulse Pressure
Upsloping LV diastolic pressure
![Page 23: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/23.jpg)
Aortic Insufficiency
![Page 24: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/24.jpg)
What is most likely diagnosis?
Aortic Insufficiency
![Page 25: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/25.jpg)
LV/RV Diastolic elevation and equilibration
Constriction or Restriction?
![Page 26: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/26.jpg)
RV/LV DiscordanceConstriction
RV/LV ConcordanceRestriction
![Page 27: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/27.jpg)
Restrictive vs Constrictive?
![Page 28: Disclosure: Morton J. Kern, MD Within the past 12 months ... · Disclosure: Morton J. Kern, MD Within the past 12 months, the presenter or their spouse/partner have had a financial](https://reader034.vdocuments.us/reader034/viewer/2022050223/5f68b12d509f84485f285381/html5/thumbnails/28.jpg)
Hemodynamics in the Cath Lab
•• Valuable diagnostic adjunctValuable diagnostic adjunct•• Confirm or establish many surgically correctableConfirm or establish many surgically correctable
etiologiesetiologies•• Confuse matters if data is poorly or inaccuratelyConfuse matters if data is poorly or inaccurately
collectedcollected•• Critical to teaching and understandingCritical to teaching and understanding
cardiovascular pathologycardiovascular pathology