Hemodynamic Rounds

Bruce R. Hopkins is a senior partner with the firm Polsinelli Shughart PC. He is also the author or coauthor of more than twenty-five books, all published by Wiley, including The Law of Tax-Exempt Organizations, Ninth Edition; The New Form 990; and Nonprofit Law Made Easy. Hopkins earned his juris doctorate and master of laws degrees at The George Washington University. He has practiced law for forty years and is a member of the District of Columbia and Missouri bars. Virginia C. Gross is a shareholder of Polsinelli Shughart PC. Ms. Gross concentrates her practice in the field of nonprofit law and is a frequent writer and speaker on nonprofit issues. She is listed in The Best Lawyers in America for nonprofit organizations/charity law for 2008 and 2009. She is a coauthor of The New Form 990, published by Wiley. Ms. Gross earned her juris doctorate at the University of Texas. She is a member of the District of Columbia, Texas, Missouri, and Kansas bars.

CONTRIBUTORS xiii
PREFACE xv
INTRODUCTION xvii
SECTION I: FUNDAMENTALS AND CLINICAL APPLICATIONS OF HEMODYNAMICS 1
PART 1: HEMODYNAMIC WAVEFORMS: NORMAL AND PATHOPHYSIOLOGIC 7
1 Pressure Wave Artifacts: Measurement Systems and Artifacts 9 Morton J. Kern and Steven Appleby
2 Pitfalls of Right-Heart Hemodynamics 17 Morton J. Kern and Steven Appleby
3 The Tricuspid Valve 23 Morton J. Kern and Steven Appleby
4 The Left-Sided V Wave 33 Morton J. Kern and Steven Appleby
5 The LVEDP 43 Morton J. Kern and Steven Appleby
6 Simultaneous Left and Right Ventricular Pressure Measurements 49 Morton J. Kern and Steven Appleby
7 Effects of Nitroglycerin 55 Morton J. Kern and Steven Appleby
8 Pulsus Alternans 63 Morton J. Kern and Steven Appleby
PART 2: VALVULAR HEART DISEASE 69
9 Aortic Stenosis 71 Abhay Laddu and Michael J. Lim
10 Aortic Regurgitation 89 Robert H. Neumayr and Michael J. Lim
11 Aortic Regurgitation Case Presentations 97 Morton J. Kern
12 Abnormal Hemodynamics After Prosthetic Aortic Root Reconstruction: Aortic Stenosis or Insufficiency? 105 Morton J. Kern, Frank V. Aguirre, and Marco Guerrero
13 Acute Aortic Insufficiency Case Presentation 111 Krystof J. Godlewski, J. David Talley, and Glenn T. Morris
14 Multivalvular Regurgitant Lesions 117 Morton J. Kern, Frank V. Aguirre, Thomas J. Donohue, and Richard G. Bach
15 The Hemodynamic Dilemma of Combined Mitral and Aortic Stenosis 123 William M. Suh and Morton J. Kern
16 Determination of the Source and Severity of a Transvalvular Left Ventricular Outflow Tract Gradient in Patients with a Prosthetic Aortic Valve 129 Michael Ragosta, D. Scott Lim, and James Bergin
17 Mitral Valve Gradients Section I 135 Morton J. Kern and Frank V. Aguirre
18 Mitral Valve Gradients Section II: Mitral Stenosis and Pulsus Alternans 143 Morton J. Kern
19 Mitral Valve Gradients Section III 149 Elie Azrak, Morton J. Kern, Richard G. Bach, and Thomas J. Donohue
20 Mitral Valve Gradients Section IV: Left Ventricular Puncture for Hemodynamic Evaluation of Double Prosthetic Valve Stenosis 155 Morton J. Kern
21 Simplified Mitral Valve Gradient Calculation by Cui et al. 161 Morton J. Kern
22 Invasive Assessment of Mitral Regurgitation: Comparison of Hemodynamic Parameters 163 Morton J. Kern
23 The Pulmonary Valve 167 Morton J. Kern
24 Percutaneous Balloon Valvuloplasty 173 Zoltan Turi and Morton J. Kern
PART 3: VALVULOPLASTY 197
25 Mitral Valve Gradients and Valvuloplasty 199 Morton J. Kern and Frank V. Aguirre
26 Reduction of Mitral Regurgitation After Aortic Valvuloplasty 205 Ted Feldman
27 Aortic Valvuloplasty in a Very Elderly Woman 211 Ted Feldman
28 Mitral Valve Gradient with Dobutamine Stress Testing 217 Ted Feldman
29 Left-Heart Catheterization and Mitral Balloon Valvuloplasty in a Patient with a Mechanical Aortic Valve 223 Douglas L. Kosmicki and Andrew D. Michaels
PART 4: HEMODYNAMICS OF PERICARDIAL CONSTRAINT, MYOCARDIAL RESTRICTION, AND TAMPONADE 229
30 Constrictive Physiology 231 Stuart T. Higano, Elie Azrak, Naeem K. Tahirkheli, and Morton J. Kern
31 Post-Cardiac Surgical Constrictive Pericardial Disease 247 Elie Azrak and Morton J. Kern
32 Pericardial Compressive Hemodynamics 253 Morton J. Kern and Frank V. Aguirre
33 Unusual Hemodynamics of Constrictive Physiology 261 Morton J. Kern and Frank V. Aguirre
34 Cardiac Tamponade 269 Morton J. Kern and Frank V. Aguirre
35 Tamponade in a Patient with AIDS-Related Non-Hodgkin s Lymphoma 277 Elie Azrak, Morton J. Kern, and Richard G. Bach
36 A Novel Assessment for Constrictive Pericarditis in a Complex Patient 283 Justin A. Strote, Larry S. Dean, Steven L. Goldberg, Eric V. Krieger, and Douglas K. Stewart
37 Why Does Kussmal s Sign and Pulsus Paradoxus Occur? 289 Morton J. Kern
PART 5: ARRYTHMIAS 293
38 Cardiac Arrhythmias 295 Morton J. Kern, Thomas J. Donohue, Richard G. Bach, and Frank V. Aguirre
39 Pacemaker Hemodynamics 301 Morton J. Kern and Ubeydullah Deligonul
PART 6: HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY 307
40 Hypertrophic Cardiomyopathy 309 Morton J. Kern, Steven Appleby, and Ted Feldman
PART 7: CORONARY HEMODYNAMICS 337
41 Coronary Hemodynamics 339 Morton J. Kern
42 Hemodynamic and Intravascular Ultrasound Assessment of an Ambiguous Left Main Coronary Artery Stenosis 367 Massoud A. Leesar and Garry S. Mintz
43 Renal Hemodynamics: Theory and Practical Tips 379 Tariq S. Siddiqui, Ziad Elghoul, Syed T. Reza, and Massoud A. Leesar
PART 8: ADULT CONGENITAL ANOMALIES 387
44 Adult Congenital Anomalies 389 Morton J. Kern, Robin Abdulmalek, Frank V. Aguirre, Thomas J. Donohue, and Richard G. Bach
45 Case Studies in Congenital Cardiac Anomalies 399 Ralf J. Holzer and Ziyad M. Hijazi
PART 9: EXTRA HEARTS 409
46 Extra Hearts: Unusual Hemodynamics of Heterotopic Transplant and Ventricular Assist Devices 411 Morton J. Kern, Ubeydullah Deligonul, and Leslie Miller
PART 10: RIGHT VENTRICULAR DYSFUNCTION 427
47 Hemodynamic Manifestations of Ischemic Right-Heart Dysfunction 429 James A. Goldstein
SECTION II: CLINICAL AND BEDSIDE APPLICATIONS OF HEMODYNAMICS 437
48 Hemodynamic Evaluation of Dyspnea 445 James A. Goldstein
49 Bedside Evaluation of Low-Output Hypotension 449 James A. Goldstein
50 Hemodynamic Evaluation of Right-Heart Failure 455 James A. Goldstein
INDEX 459