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Trans-Catheter Pulmonary Valve Implantation
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March 13, 2014
History:
• A.S. is a 17 year old male born with TOF.
• 2 month ...
read more ↘ old (2/1996; Haas) – Complete repair with transannular patch
• Developmentally delayed, b/l deafness with cochlear implants
• Foster parents, felt to be asymptomatic
Physical Findings:
• HR 90/min, RR 18/min, BP 117/76, O2 Sat 100%, 48.6kg
• HEENT/Neck: Microcephalic, no JVD
• CV: well healed midline sternotomy, dynamic precordium, reg rate, clear S1, single S2, 3/6 to-fromurmur over LUSB
Ext: warm, 2+pulses in UE and LE, no LE edema
Pertinent Tests:
EKG:
• Normal sinus rhythm, RBBB, QRS duration 145ms
Echo:
• Mild TR –RVp ~34mmHg+RAp
• Mild PS (PSG 27mmHg, mean Doppler gradient 17mmHg)
• Severe PR, with flow reversal in BPA’s
• Moderate-severe RV dilation
• RV function fair to normal (subjective)
• Normal LV function (EF 60%)
MRI:
• Contraindicated due to cochlear implants
Cath (10/2012):
• C.I. 3.5 L/min/m2
• Mild PS
• Severe PR
• Moderate RV dilation
↖ read less
• A.S. is a 17 year old male born with TOF.
• 2 month ...
read more ↘ old (2/1996; Haas) – Complete repair with transannular patch
• Developmentally delayed, b/l deafness with cochlear implants
• Foster parents, felt to be asymptomatic
Physical Findings:
• HR 90/min, RR 18/min, BP 117/76, O2 Sat 100%, 48.6kg
• HEENT/Neck: Microcephalic, no JVD
• CV: well healed midline sternotomy, dynamic precordium, reg rate, clear S1, single S2, 3/6 to-fromurmur over LUSB
Ext: warm, 2+pulses in UE and LE, no LE edema
Pertinent Tests:
EKG:
• Normal sinus rhythm, RBBB, QRS duration 145ms
Echo:
• Mild TR –RVp ~34mmHg+RAp
• Mild PS (PSG 27mmHg, mean Doppler gradient 17mmHg)
• Severe PR, with flow reversal in BPA’s
• Moderate-severe RV dilation
• RV function fair to normal (subjective)
• Normal LV function (EF 60%)
MRI:
• Contraindicated due to cochlear implants
Cath (10/2012):
• C.I. 3.5 L/min/m2
• Mild PS
• Severe PR
• Moderate RV dilation
↖ read less
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