6 |
Z Score (Established by Rowlatt, Rinoldi and Lev) |
OBSERVED VALUE
– EXPECTED VALUE/STANDARD DEVIATION (S.D.) OF THE EXPECTED
VALUE |
7
|
Transannular patch enlargement (TAPE) of the pulmonary valve
|
PULMONARY VALVE ANNULUS (PVA) SIZE / AORTIC VALVE ANNULUS (AVA) SIZE
TAPE = OR PVA / AVA
GREAT ARTERY ANNULUS SIZE RATIO [GA RATIO]
|
Intraoperative - PRV: LV Ratio {Kirklin’s Index} <
0.7 = optimal > 0.8 = TAPE |
Intraoperative - PRV:
LV Ratio {Kirklin’s Index} < 0.7 = optimal >
0.8 = TAPE |
Intraoperative - PRV: LV Ratio {Kirklin’s Index}
< 0.7 = optimal > 0.8 = TAPE |
Postoperative |
Postoperative |
Postoperative |
8
|
Tricuspid Annular Plane Systolic Excursion (TAPSE)
|
TAPSE is another two-dimensional measure with which one can assess
systolic right ventricular function.
TAPSE in pediatric patients.
Normal
>12 mm.
Mild RV dysfunction
10–12 mm.
Moderate RV dysfunction
8–10 mm.
Severe RV dysfunction
<7 mm.
|
9
|
Fractional Area Change (FAC)
|
The fractional area change is a two-dimensional measure of right
ventricular global systolic function.
RV FAC (%)
Reference range
32%–60%
Mild abnormal
25%–31%
Moderate abnormal
18%–24%
Severe abnormal
<17%
|
10
|
Pulmonary Regurgitation (PR) in Postoperative TOF for Determining Right
Ventricular Contractile Dysfunction
|
PR is classified as:
Mild (No retrograde diastolic flow in the pulmonary trunk with a
detectable regurgitant jet in the RV outflow tract)
Moderate (retrograde diastolic flow in the main pulmonary artery)
Severe (additional retrograde diastolic flow in branch PAs).
|
11
|
Isovolumic Myocardial Acceleration (IVA)
|
Experimental and a clinical study as a new tissue Doppler-based index of
systolic RV function post-TOF repair.
- IVA demonstrates reduced contractile function in relation to the
degree of PR and may be an early, sensitive index for selecting patients
for valve replacement.
|
12
|
Pulmonary Regurgitation (PR) used to calculate pulmonary artery
diastolic pressure (using the modified bernoulli equation) and mean
pulmonary artery pressure
|
PADP = RVEDP + Δ Ppv
Where,
PADP = Pulmonary artery diastolic pressure
RVEDP = Right ventricular diastolic pressure
Δ Ppv = Equals the pressure gradient between the pulmonary artery and
right ventricular outflow tract.
Calculate the end-diastolic gradient between the pulmonary artery and
right ventricular outflow tract from the velocity of the pulmonary
regurgitation jet.
Add, assumed RVDP = RAP, then the equation can be applied - PADP = RVEDP
+ Δ Ppv
PAmean = (PASystolic + 2
PAdiastolic) / 3
|