Eduardo R Argaiz Profile picture
Attending Nephrologist @incmnszmx | Board Member at the Mexican Society of Echocardiography @SONECOM_AC | #Hemodynamics #EchoFirst

Oct 21, 2021, 6 tweets

Pt w right HF and high probability pulmonary hypertension

TAPSE 15 mm, TRVmax 4.1 m/s, paradoxical septal motion

Renal Venous Doppler ๐Ÿ‘‡

According to doi.org/10.1161/JAHA.1โ€ฆ, Which curve color would best describe this patient's PH-related morbidity?

Poll and ๐Ÿงต๐Ÿ‘‡

1/6

Which curve in the Kaplan Meier Curve above best fits this particular patient?

2/6

The Renal Doppler shown ๐Ÿ‘† looks like a biphasic pattern. This would mean the green curve ๐ŸŸข

However there is a catch.....

3/6

This is not the correct location for evaluating renal congestion

It should be done in an intra-renal vein (arcuate, interlobar) and NOT the main renal vein!

The main renal vein displays more pulsatility than intra-renal veins.

This is an example from a healthy person:

4/6

In fact, this is the actual interlobar renal vein from the case discussed.

It is definitely NOT biphasic. I would call it pulsatile.

So the answer is the red ๐Ÿ”ด curve!

5/6

IRV Doppler can sometimes be hard to get and can easily be misinterpreted. This is why #VExUS exists!

In this case IVC was non plethoric, hepatic and portal veins had normal flow patterns (#VExUS = 0) arguing agains a "biphasic" intra-renal venous flow!

END/

Share this Scrolly Tale with your friends.

A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.

Keep scrolling