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Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics

Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics. UNIFESP. Diego Gaia MD PhD drgaia@uol.com.br. Input impedance: in practice ?. Z = P/Q. Wave reflection. explains patho-physiological changes in blood pressure

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Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics

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  1. Effects of endovascular treatment of thoracic aortic diseases on aortic hemodynamics UNIFESP Diego Gaia MD PhD drgaia@uol.com.br

  2. Input impedance: in practice ? Z = P/Q

  3. Wave reflection • explains patho-physiological changes in blood pressure • early return of reflected wave: ‘boost’ of systolic pressure • extra load on the heart • What is the influence of aortic prosthesis / stent-graft placement ?

  4. Type B / DTA • PWV / Impedance / PP / Aix / Reflexion • Day before • During procedure • 1 PO • 7 PO • 30 PO • 60 PO • 180 PO • 360 PO

  5. Pulse tonometry

  6. Flow: Echocardiogram

  7. Pressure and flow: before and after endoprosthesis deployment Before After Pressure: Flow:

  8. Type B Dissections 23 % 34 %

  9. DTA

  10. Pulse WaveVelocity – Femoral / Carotid 20 %

  11. Conclusions • Aorticstiffness MACE • Stent-graftcanincreaseaorticstifnessandleft ventricular afterload (Impedance/PWV) • Negative cardiovascular impact • Deviceimprovementos – compliance / stiffness

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