The most Sensitive Imaging Technique for Assessment of Fluid Overload after TAVR and MitraClip A First-in Man Technique Thach Nguyen MD FACC FSCAI Methodist Hospital, Merrillville IN Joint Coronary Revascularization Busan Korea Saturday December 9, 2016

Symptoms and Signs of Heart Failure Are Non Specific

The same symptom (shortness of The same symptom (shortness of breath) and sign (edema) can be found in Heart failure, COPD, Chronic kidney failure Cirrhosis of the liver Pulmonary hypertension Pericarditis

Extravascular Fluid Overload In patients with chronic left ventricular failure and a low cardiac output, extracellular fluid volume may be sufficiently expanded to cause edema in the presence of slight elevations of systemic venous pressure

Intravascular Fluid Overload In patients with chronic left ventricular failure and a low cardiac output, extracellular fluid volume may be sufficiently expanded to cause edema in the presence of slight elevations of systemic venous pressure

The first principle: The volume of blood going through the femoral artery and returning through the common femoral vein should be the same. If so, in normal condition, the size of the femoral artery and the femoral vein should be the same. The ultrasound plane of the femoral artery and vein to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery. (Figure 3) In patients with normal fluid status, the size of the femoral vein is similar to the size of the common femoral artery.

Femoral Artery Femoral Vein

Vascular Probe with Regular Echo Equipment

Location to measure the size of the femoral artery and vein

ASYMTPOMATIC Patient with Fluid Overload Femoral Artery Much larger femoral vein

Enlarged femoral vein due to fluid overload and this is the start of heart failure In patients with chronic left ventricular failure and a low cardiac output, extracellular fluid volume may be sufficiently expanded to cause edema in the presence of slight elevations of systemic venous pressure

Patient with Bleeding Femoral Artery Smaller Femoral Vein

This new technique is useful in…

1. Diagnosis of heart failure, 2 1. Diagnosis of heart failure, 2. Extent of internal acute blood loss, 3. Diagnosis of syncope 4. Diagnosis of orthostatic hypotension, 5. Confirm HF in patient with COPD, 6. Confirm HF with chronic kidney dis. 7. Confirm HF in patient with cirrhosis 8. Confimr fluid overload in patient with normal EF (misnomer diastolic HF)

Clinical trials are underway to calculate the sensitivity and specificity of this technique in the diagnosis of heart failure and the efficacy in the management of complex heart failure

Extravascular Fluid Overload In patients with chronic left ventricular failure and a low cardiac output, extracellular fluid volume may be sufficiently expanded to cause edema in the presence of slight elevations of systemic venous pressure

Intravascular Fluid Overload In patients with chronic left ventricular failure and a low cardiac output, extracellular fluid volume may be sufficiently expanded to cause edema in the presence of slight elevations of systemic venous pressure

Patient with Fluid overload Femoral Artery Much larger femoral vein

Clinical trials are underway

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