of constrictive pericarditis 缩窄性心包炎的血流动力学课件

Hemodynamics of constrictive pericarditis Restrictive physiology Restrictive physiology is characterised by impediment to ventricular filling caused by Increased ventricular stiffness-RCM Increased pericardial restraint-CCP Constrictive pericarditis and restrictive cardiomyopathy share clinical features and hemodynamic findings Preserved systolic function. Grade III diastolic dysfunction. Elevation and equalization of diastolic pressures Dip and plateau pattern in Ventricular pressure tracing Pericardium Pericardium-2 layers Visceral-monolayer of mesothelial cells ,collagen 93:2007-2013 Copyright American Heart Association CCP RA pressures Restricted filling-elevation of mean pressure Early diastole-rapid filling-prom. Y descent Elevated RAP Suction effect due to decreased ESV Friedreich sign Abrupt cessation of ventricular filling-nadir of Y descent kussmaul s sign Inspiratory increase in venous return-decr.ITP Failure of transmission of decr.ITP to RV Ventricular interdependence is modest Ventricular pressure tracing Early diastole Filling of ventricles unimpeded Rapid-high RAP,decreased ESV Ventricular RFW 7 mmHg Abrupt halt to ventricular filling once the limit set by the pericardium Dip and plateau pattern Equalisation of LV 93:2007-2013 Copyright American Heart Association Systolic area index RV area/LV area in inspirationRV area /LV area in expiration 1.1 s/o CCP FEATURE SENSITIVITY% SPECIFICITY% LVEDP RVEDP 1/3 93 46 PA SP 7 mm Hg 45 44 RESPIRATORY RAP 1.1 97 100 D R Talreja JACC 2008;51:315 Echo-M mode Septum- Rapid movements in early diastole and atrial contraction Postr wall Abrupt postr motion in early diastole and flat in diastole Sharp EF slope in MV M-mode Echo Doppler Mitral peak E velocity25 % increase in exp. Tricuspid peak E velocity 25 % increase in insp. DT2 Echo features-doppler PV doppler S D in expiration Diastolic flow reversal in expiration HV diastolic flow reversal in expiration TDI Mitral annular E8 cm/s E/E 15 Variant forms Effusive constrictive Failure of RAP to decline by at least 50% to a level below 10 mm Hg when pericardial pressure decreased to 0 by pericardiocentesis Occult