Case 1: 

• • TR has a velocity of 4m/s. There is also a pulmonary valvular stenosis with a gradient of 2 m/s

    • What is the RV systolic pressure 

    • What is the PA systolic pressure

  • If the Aortic pressure is 98 mmHg, what would be the directionality and  the expected peak velocity through the ductus

Case 2: 

• Blood pressure is 100/55 mmHg in Aorta

• VSD gradient restrictive is left to right and 45 mmHg of gradient.

• There is an Aortic Valvular Gradient because of aortic valve stenosis of 65 mmHg. 

• What is the RV systolic pressure. What is the PA systolic pressure.

Case 3:

• The Aortic blood pressure is 110/60

• The LVOT gradient through aortic stenosis is 60 mmHg

• What is the LV systolic pressure?

• If you assume a LA pressure of around 10 mmHg. What would be the MR velocity gradient?

Case 4:

• A PDA is left to right with a gradient of 80 mmHg

• The Aortic pressure (systolic) is 100 mmHg

• The TRJ gives a RV systolic pressure of 130 mmHg of RV-RA gradient.

• What is the PA systolic pressure?

• What is the RV systolic pressure? 

• What is the gradient via the RVOT? 

Case 5: 

• • If Ao saturation=100%, Mixed venous saturation=70%, Pulmonary Venous saturation=100%, and Pulmonary arterial saturation=85% (indicating oxygen enrichment from the shunt), then Qp/Qs is ?

Case 6: Large left to right VSD:

• Aortic pressure is 90/60 (mean 70)

• The LA pressure is 15 mmHg. RA pressure is 5 mmHg.

• mPAP is 30 mmHg

• There is no hepatomegaly (low IVC pressure).

• The LV is dilated on echocardiography (LV end-diastolic diameter with a Z-score 3.5) due to the high pulmonary blood flow by the left to right shunt. 

• Qp >> Qs because the LA and LV are dilated. 

• If Qp/Qs = 3, what is the pulmonary vascular resistance to systemic vascular resistance ratio?

Case 7: Large VSD on echocardiography 

• • The patient has an aortic blood pressure of 110/60 (85 mean). By cath, the PA saturation is 70%. The pulmonary venous saturation is 100%. The Aortic saturation is 100%. The RA saturation is 70%. Mean PAP is 45 mmhg, Mean LA pressure is 10 mmHg, Mean Aortic pressure is 70 and Mean RA pressure is 5. 

  • What is the Rp/Rs?

  • What is the Qp/Qs?

Case 8 - Large right to left VSD

• Is the Rp/Rs ratio less or more than 1?

• Ao saturation is 85%, SVC saturation is 55 (AV difference of 30%). PA saturation is 55%. There is no VQ mismatch. What is the Qp/Qs?

• The patient has an aortic blood pressure of 110/60 (85 mean). PA pressure is: 110/38 (mean 70). RA pressure is 5, LA pressure is 10.

• What is the Rp/Rs Ratio?

Case 9

• Central venous line reads a pressure of 10 mmHg

• The PFO gradient is restrictive and estimating a peak gradient of 15 mmHg

• There is a prolonged retrograde flow in the pulmonary vein.

• What would be the LA pressure?

• What could explain this rise in LA pressure?

Case 10

• At baseline, the patient is evaluated in room air with iNO at 10 ppm. 

  • RA pressure is 5 mmHg with a RA saturation of 69% (SVC saturation 72%, IVC satuation 67%). The saturation at the LPA is also 69%. 

  • Is there a left to right shunt at a VSD or PDA level? 

  • The RV pressures are 44/4 compared to LV pressures of 82/8. Is the RV pressure infra, supra, or isosystemic?

  • The MPA pressure is 45/17 (mean of 30). Is this pulmonary hypertension?

  • The RPA and LPA pressure are similar (46/19; mean 30 for the RPA; 48/19; mean 30 for LPA). Is there obstruction of the RPA or LPA, could it be a sadle emboli? 

  • The wedge pressure on both side is similar (9 and 10 mmHg). Is there pulmonary venous hypertension? 

Case 11

• Blood pressure is 29/10 and saturation post-ductal is 65%

• Pre-ductal saturation is 85%

• There is minimal V/Q mismatch on the chest radiography with nice aeration of the lungs

• On ECHO the TRJ gives RV-RA of 25 mmHg

• The PDA is large and strictly right to left

• There is retrograde flow in the Ascending Arch.

• The PFO is shunting strictly left to right. 

• What would be your management of this patient? What is the phenotype of the patient?

• What is the expected saturation in the left atrium?

• What would be the expected saturation in the LV?

• What would be the expected saturation in the RA?

• What would be the expected saturation in the RV? What is the expected blood presure in the RV?

• What is the expected sPAP and diastolic PAP?

Case 12

• Blood pressure is 29/10 and saturation post-ductal is 75%

• Pre-ductal saturation is 75%

• There is minimal V/Q mismatch on the chest radiography with nice aeration of the lungs

• The PDA is large and strictly left to right

• The PFO is shunting strictly right to left. The patient has significant hepatomegaly.

• There is no congenital heart defect (outside of the inter-atrial shunt and PDA presence). 

• What would be your management of this patient? What is the phenotype of the patient?

• What is the expected saturation in the left atrium?

• What would be the expected saturation in the LV?

• What would be the expected saturation in the RA?

• What would be the expected saturation in the RV? 

• What is the expected sPAP and diastolic PAP?