Chicago Hemodynamic Forum Case.pptx

1、The Clot Thickens,18 yo male finishing secondary schoolPreviously healthy,loves the RaptorsDiagnosed with Behcets Disease 1 year priorBilateral DVT and Recurrent PEAnticoagulation interrupted for appendectomy and receives IVC filterCurrently well at rest,but dyspneic with leg fatigue after moderate

2、exertion and cannot play basketballEcho,Normal RV and LV,RVSP estimated at 25 mmHgVO2 peak 17 ml/kg/min,50%pred,RER 1.15,increased VE/VCO2 slope,VO2/HR 8VQ scan persistent small matched defectCTPE subsegmental burden of disease RLL,What Next?,PH is unlikely,pulmonary endarterectomy surgery is not in

3、dicated,continue anticoagulation?Offer balloon pulmonary angioplasty?Resting right heart catheterization?Exercise hemodynamics because probability of latent PAH is high?In the supine position?Upright position with metabolic exercise testing?,Referred for exercise hemodynamics:Supine resting hemodyna

4、mics Ht 180cm,Wt 70kg,BSA 1.9 m2,Transferred to the cycle ergometer,semi upight posture,SUMMARYNormal resting hemodynamicsCO increases based on exaggerated HR response for workrateSV index is low with minimal increaseNo exercise PH foundRA and PAWP decline with exerciseDiagnosis:“Preload insufficiency”,Clotted IVC filter and occlusion with impaired venous return via small collaterals,Similar case-40 yo female 50%pred VO2maxAbnormal Resistive and Pulsatile Loading PEA performed,