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

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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 In practice: Pressure and flow are measured and decomposed in their harmonics, input impedance is calculated for each harmonic as the ratio of pressure and flow components. The result is frequency-dependent modulus and phase angle. This pattern is not flat! The fact that the phase angle fluctuates between negative and positive values indicates that there are reflections.

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 ? An early return of the backward wave causes a boost of systolic pressure and thus an extra load on the heart

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

Pulse tonometry

Flow: Echocardiogram

Pressure and flow: before and after endoprosthesis deployment

Type B Dissections 23 % 34 %

DTA

Pulse Wave Velocity – Femoral / Carotid 20 %

Conclusions Aortic stiffness  MACE Stent-graft can increase aortic stifness and left ventricular afterload (Impedance/PWV) Negative cardiovascular impact Device improvementos – compliance / stiffness O que se sabe do toracico cir[urgicodisquete i dois trabalhos do journal