1. 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

2. Symptoms and Signs of Heart Failure Are Non Specific

3. 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

4. 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

5. 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

9. 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.

10. Femoral Artery
Femoral Vein

11. Vascular Probe with Regular Echo Equipment

12. Location to measure the size of the femoral artery and vein

13. ASYMTPOMATIC Patient with Fluid Overload
Femoral Artery
Much larger femoral vein

14. 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

15. Patient with Bleeding
Femoral Artery
Smaller Femoral Vein

18. This new technique is useful in…

19. 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)

20. 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

23. 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

24. 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

26. Patient with Fluid overload
Femoral Artery
Much larger femoral vein

27. Clinical trials are underway

28. THANK YOU