Haemodynamic calculations in the catheter laboratory

Many of the calculations used in the evaluation of haemodynamic abnormalities are relatively simple and can be performed rapidly with a hand held calculator or (for the mentally agile) “in the head”. Others are more complex and require a more time consuming process of analysis of the recorded data, often performed some time after the actual procedure. Currently available catheter laboratory equipment for physiological monitoring and analysis will often provide a range of semi automatic calculations which will save time and allow the production of a comprehensive report at the conclusion of the procedure. It is vital, however, that cardiologists continue to have a clear understanding of the basis of such calculations and the limitations/pitfalls intrinsic to them and to some of the data on which they are based. Some of the calculations that can be made are of limited clinical utility while others are potentially misleading unless the data from which they are derived are carefully checked for accuracy and have been obtained using rigorous methodology. When, as is all too often the case, the data have been acquired largely automatically and have not been carefully scrutinised by someone familiar with the potential errors, the figures for pulmonary and systemic blood flow, shunt flows and resistances may be almost meaningless and can readily lead to inappropriate and potentially dangerous decisions. In practice most of the important calculations—shunt ratio (Qp:Qs), pulmonary blood flow, and pulmonary vascular resistance—can be estimated, albeit imprecisely, on the basis of straightforward and quick “guesstimates” which provide a rapid and generally useful “cross check” of the figures produced by the computer (or by a more time consuming and comprehensive manual method). While such rapid calculations are not a substitute for a careful and detailed analysis of the data, they are an effective way of understanding how …