Aortic Valve Disease Normal Aortic Valve Parasternal long
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![Aortic Valve Disease Aortic Valve Disease](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_1.jpg)
![Normal Aortic Valve Parasternal long axis view Three cusps (right, left Normal Aortic Valve Parasternal long axis view Three cusps (right, left](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_2.jpg)
![Parasternal short axis view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2 Parasternal short axis view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_3.jpg)
![Apical five chamber view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2 Apical five chamber view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_4.jpg)
![M-Mode Separation: 2 cm Maximal Velocity (LVOT): 0.7-1.1 m/s Maximal Velocity (Aorta): 1.0-1.7 m/s M-Mode Separation: 2 cm Maximal Velocity (LVOT): 0.7-1.1 m/s Maximal Velocity (Aorta): 1.0-1.7 m/s](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_5.jpg)
![Congenital Anomaly Unicuspid valve Bicuspid valve Quadricuspid valve Congenital Anomaly Unicuspid valve Bicuspid valve Quadricuspid valve](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_6.jpg)
![Bicuspid Aortic Valve Most common congenital anomaly (population 1-2%) Systolic doming: PLAX Fish mouth Bicuspid Aortic Valve Most common congenital anomaly (population 1-2%) Systolic doming: PLAX Fish mouth](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_7.jpg)
![commissure raphe Combined aortic aneurysm or AS Normal (15%), stenosis(72%), regurgitation (4%), endocarditis commissure raphe Combined aortic aneurysm or AS Normal (15%), stenosis(72%), regurgitation (4%), endocarditis](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_8.jpg)
![Quadricuspid Aortic Valve Quadricuspid Aortic Valve](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_9.jpg)
![Aortic Stenosis Aortic Stenosis](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_10.jpg)
![2D Echocardiography Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation and doming 2D Echocardiography Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation and doming](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_11.jpg)
![Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation Commissural fusion (in rheumatic Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation Commissural fusion (in rheumatic](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_12.jpg)
![Etiology of Aortic Stenosis Eur Heart J 2003;24:1231 Degenerative-calcific 81.9% Rheumatic 11.2% Etiology of Aortic Stenosis Eur Heart J 2003;24:1231 Degenerative-calcific 81.9% Rheumatic 11.2%](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_13.jpg)
![Morphologic Characteristics Degenerative-Calcific Rheumatic Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural Morphologic Characteristics Degenerative-Calcific Rheumatic Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_14.jpg)
![Degenerative vs. Rheumatic AS Thick, stiff leaflets No commissural fusion Degenerative Rheumatic Multivalvular involvement Degenerative vs. Rheumatic AS Thick, stiff leaflets No commissural fusion Degenerative Rheumatic Multivalvular involvement](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_15.jpg)
![Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural fusion Degenerative Rheumatic Degenerative vs. Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural fusion Degenerative Rheumatic Degenerative vs.](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_16.jpg)
![Membraneous Subaortic Stenosis Membraneous Subaortic Stenosis](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_17.jpg)
![Doppler Examination Time (s) Pressure (mm Hg) Maximum gradient by Doppler exam Doppler Examination Time (s) Pressure (mm Hg) Maximum gradient by Doppler exam](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_18.jpg)
![Peak pressure gradient Mean pressure gradient Modified Bernoulli Equation Pressure Gradient = Peak pressure gradient Mean pressure gradient Modified Bernoulli Equation Pressure Gradient =](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_19.jpg)
![Angle Dependency Doppler Examination Angle Dependency Doppler Examination](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_20.jpg)
![Differential Diagnosis of LVOT Obstruction Valvular Aortic Stenosis Subaortic Membrane Differential Diagnosis of LVOT Obstruction Valvular Aortic Stenosis Subaortic Membrane](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_21.jpg)
![Other High Velocity Systolic Jets that May Be Mistaken for Aortic Stenosis Other High Velocity Systolic Jets that May Be Mistaken for Aortic Stenosis](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_22.jpg)
![Calculation of Valve Area 2D Planimetry Continuity equation Calculation of Valve Area 2D Planimetry Continuity equation](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_23.jpg)
![2D Planimetry Severe calcification: difficult to measure AVA (should trace 80% of 2D Planimetry Severe calcification: difficult to measure AVA (should trace 80% of](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_24.jpg)
![Should measure oritice tip of AV Subvalvular Area 1.30 cm2 Orifice Tip Should measure oritice tip of AV Subvalvular Area 1.30 cm2 Orifice Tip](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_25.jpg)
![Continuity Equation LVOT Stroke Volume = AS-Jet Stroke Volume LVOT CSA x Continuity Equation LVOT Stroke Volume = AS-Jet Stroke Volume LVOT CSA x](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_26.jpg)
![LVOT 2D Measure Continuity Equation LVOT 2D Measure Continuity Equation](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_27.jpg)
![Continuity Equation Continuity Equation](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_28.jpg)
![Severity of Aortic Stenosis Mild Moderate Severe Severity of Aortic Stenosis Mild Moderate Severe](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_29.jpg)
![Quantification of Stenosis Severity Quantification of Stenosis Severity](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_30.jpg)
![AS with Low Pressure Gradient Low Output with Low Pressure Gradient AS with Low Pressure Gradient Low Output with Low Pressure Gradient](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_31.jpg)
![Aortic Regurgitation Aortic Regurgitation](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_32.jpg)
![Etiology of Aortic Regurgitation Cusp pathology Aortic wall pathology including aortitis Congenital Etiology of Aortic Regurgitation Cusp pathology Aortic wall pathology including aortitis Congenital](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_33.jpg)
![Cusp Pathology (Including congenital) Rheumatic Degenerative Infective endocarditis Congenitally bicuspid valve Ass. with Cusp Pathology (Including congenital) Rheumatic Degenerative Infective endocarditis Congenitally bicuspid valve Ass. with](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_34.jpg)
![Rheumatic AR Rheumatic AR](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_35.jpg)
![Degenerative AR Degenerative AR](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_36.jpg)
![Infective Endocarditis Infective Endocarditis](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_37.jpg)
![Bicuspid Aortic Valve Bicuspid Aortic Valve](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_38.jpg)
![Quadricuspid Aortic Valve Quadricuspid Aortic Valve](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_39.jpg)
![Ventricular Septal Defect Ventricular Septal Defect](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_40.jpg)
![Ventricular Septal Defect Ventricular Septal Defect](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_41.jpg)
![Aortic Valve Prolapse Best seen in parasternal long axis view Disruption of commissural support Aortic Valve Prolapse Best seen in parasternal long axis view Disruption of commissural support](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_42.jpg)
![Aortic Valve Prolapse (TTE) Aortic Valve Prolapse (TTE)](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_43.jpg)
![Aortic Valve Prolapse (TEE) Aortic Valve Prolapse (TEE)](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_44.jpg)
![Aortic Root Disease Aortic dilatation related with - Hypertension - Age-related Aortic Root Disease Aortic dilatation related with - Hypertension - Age-related](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_45.jpg)
![Effacement of the Sinotubular Junction Hypertension, Degeneration, Bicuspid AV Effacement of the Sinotubular Junction Hypertension, Degeneration, Bicuspid AV](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_46.jpg)
![Aortic Dissection Aortic Dissection](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_47.jpg)
![Marfan Syndrome-I Marfan Syndrome-I](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_48.jpg)
![Marfan Syndrome-II Marfan Syndrome-II](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_49.jpg)
![Behcet’s Disease Behcet’s Disease](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_50.jpg)
![Behcet’s Disease vs. Takayasu’s Arteritis JASE 2003;16:850 Behcet’s Disease vs. Takayasu’s Arteritis JASE 2003;16:850](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_51.jpg)
![M-Mode AMVL fluttering in diastole Premature closure of MV and Diastolic opening of M-Mode AMVL fluttering in diastole Premature closure of MV and Diastolic opening of](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_52.jpg)
![Estimating the Severity of AR Color Flow Estimating the Severity of AR Color Flow](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_53.jpg)
![Color Flow Jet Area/Jet Height Color Flow Jet Area/Jet Height](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_54.jpg)
![Jet Area/Jet Height Instrument (gain) dependent, Eccentric Jet, Temporal variability Multiple jets or Jets Jet Area/Jet Height Instrument (gain) dependent, Eccentric Jet, Temporal variability Multiple jets or Jets](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_55.jpg)
![Vena Contracta Width (Semiquantification Method) Most narrow point : just below flow convergence Vena Contracta Width (Semiquantification Method) Most narrow point : just below flow convergence ](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_56.jpg)
![Vena Contracta Width (Semiquantification Method) Color Flow Vena Contracta Width (Semiquantification Method) Color Flow](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_57.jpg)
![Color Flow Flow Convergence or PISA Multiple measurements, Technically challenging AV calcification, Multiple jets, Color Flow Flow Convergence or PISA Multiple measurements, Technically challenging AV calcification, Multiple jets,](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_58.jpg)
![Continuous Wave Doppler CW Doppler Signal Density Qualitative Overlap between moderate and severe AR Continuous Wave Doppler CW Doppler Signal Density Qualitative Overlap between moderate and severe AR](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_59.jpg)
![Continuous Wave Doppler Mild Severe Diastolic Jet Deceleration Continuous Wave Doppler Mild Severe Diastolic Jet Deceleration](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_60.jpg)
![Pulsed Wave Doppler Descending Thoracic Aorta Abdominal Aorta Descending Aorta Holodiastolic Flow Reversal Aortic Pulsed Wave Doppler Descending Thoracic Aorta Abdominal Aorta Descending Aorta Holodiastolic Flow Reversal Aortic](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_61.jpg)
![Pulsed Wave Doppler Regurgitation Volume and Fraction Aortic Regurgitant Volume = SVAV - SVMV Pulsed Wave Doppler Regurgitation Volume and Fraction Aortic Regurgitant Volume = SVAV - SVMV](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_62.jpg)
![Pulsed Wave Doppler Regurgitation Volume and Fraction Require multiple measurements Assumes no regurgitation at Pulsed Wave Doppler Regurgitation Volume and Fraction Require multiple measurements Assumes no regurgitation at](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_63.jpg)
![Quantification of AR Severity Quantification of AR Severity](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_64.jpg)
![Mild Moderate Severe Regurgitant jet width/LVOT diameter Regurgitant jet area/LVOT area PHT of CW Mild Moderate Severe Regurgitant jet width/LVOT diameter Regurgitant jet area/LVOT area PHT of CW](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_65.jpg)
![Acute versus Chronic AR Acute versus Chronic AR](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_66.jpg)
![Acuity of AR Shape of AR on CW Doppler Premature Closure of Acuity of AR Shape of AR on CW Doppler Premature Closure of](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_67.jpg)
![Thank You ! Thank You !](https://present5.com/presentacii-2/20171208\19664-5-2_aortic_valve_disease.ppt\19664-5-2_aortic_valve_disease_68.jpg)
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19664-5-2_aortic_valve_disease.ppt
- Количество слайдов: 68
Aortic Valve Disease
Normal Aortic Valve Parasternal long axis view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2 Separation: 2cm
Parasternal short axis view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2 Separation: 2cm Normal Aortic Valve
Apical five chamber view Three cusps (right, left and non-coronary) Valve area: 3-4 cm2 Separation: 2cm Normal Aortic Valve
M-Mode Separation: 2 cm Maximal Velocity (LVOT): 0.7-1.1 m/s Maximal Velocity (Aorta): 1.0-1.7 m/s CW Doppler Normal Aortic Valve
Congenital Anomaly Unicuspid valve Bicuspid valve Quadricuspid valve
Bicuspid Aortic Valve Most common congenital anomaly (population 1-2%) Systolic doming: PLAX Fish mouth appearance : PSAX
commissure raphe Combined aortic aneurysm or AS Normal (15%), stenosis(72%), regurgitation (4%), endocarditis (9%) Doppler is important Bicuspid Aortic Valve
Quadricuspid Aortic Valve
Aortic Stenosis
2D Echocardiography Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation and doming Left ventricular hypertrophy
Normal Aortic Stenosis Cusp calcification and thickening Cusp motion limitation Commissural fusion (in rheumatic AS) 2D Echocardiography
Etiology of Aortic Stenosis Eur Heart J 2003;24:1231 Degenerative-calcific 81.9% Rheumatic 11.2% Congenital (ex. Bicuspid etc) 5.6% Post endocarditis 1.3% Euro Heart Survey on Valvular Heart Disease
Morphologic Characteristics Degenerative-Calcific Rheumatic Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural fusion
Degenerative vs. Rheumatic AS Thick, stiff leaflets No commissural fusion Degenerative Rheumatic Multivalvular involvement Commissural fusion
Thick, stiff leaflets No commissural fusion Multivalvular involvement Commissural fusion Degenerative Rheumatic Degenerative vs. Rheumatic AS
Membraneous Subaortic Stenosis
Doppler Examination Time (s) Pressure (mm Hg) Maximum gradient by Doppler exam Peak-to-peak gradient by Catheter exam Mean gradient LV and Aortic Pressures measured with catheter in a patient with severe AS
Peak pressure gradient Mean pressure gradient Modified Bernoulli Equation Pressure Gradient = 4 x Vmax2 4 x 4.622 = 85.3 mmHg Tracing of Velocity Curve Mean Pressure Gradient 60.9 mmHg Doppler Examination
Angle Dependency Doppler Examination
Differential Diagnosis of LVOT Obstruction Valvular Aortic Stenosis Subaortic Membrane Hypertrophic Cardiomyopathy
Other High Velocity Systolic Jets that May Be Mistaken for Aortic Stenosis Mitral regurgitation Tricuspid regurgitation Supravalvular stenosis Ventricular septal defect Pulmonic or branch pulmonary artery stenosis Peripheral vascular stenosis (e.q., subclavian artery) Aortic Stenosis Mitral Regurgitation
Calculation of Valve Area 2D Planimetry Continuity equation
2D Planimetry Severe calcification: difficult to measure AVA (should trace 80% of AVA)
Should measure oritice tip of AV Subvalvular Area 1.30 cm2 Orifice Tip 0.76 cm2 2D Planimetry
Continuity Equation LVOT Stroke Volume = AS-Jet Stroke Volume LVOT CSA x LVOT TVI = AVA x AS-Jet TVI AVA = (LVOT CSA x LVOT TVI) / AS-Jet TVI
LVOT 2D Measure Continuity Equation
Continuity Equation
Severity of Aortic Stenosis Mild Moderate Severe
Quantification of Stenosis Severity
AS with Low Pressure Gradient Low Output with Low Pressure Gradient (AVA < 1.0 cm2 and PG < 30 mmHg)
Aortic Regurgitation
Etiology of Aortic Regurgitation Cusp pathology Aortic wall pathology including aortitis Congenital
Cusp Pathology (Including congenital) Rheumatic Degenerative Infective endocarditis Congenitally bicuspid valve Ass. with membraneous subaortic aortic stenosis Ass. with ventricular septal defect Aortic valve prolapse (Myxomatous or congenitally abnormal) Less common - Unicommissural and quadricuspid valve - Rupture of a fenestrated valve - SLE, RA, Ankylosing spondylitis, Takayasu disease, Whipple disease, Crohn disease etc
Rheumatic AR
Degenerative AR
Infective Endocarditis
Bicuspid Aortic Valve
Quadricuspid Aortic Valve
Ventricular Septal Defect
Ventricular Septal Defect
Aortic Valve Prolapse Best seen in parasternal long axis view Disruption of commissural support - Dissection - Dilatation - Ass. with VSD - Myxomatous or congenitally abnormality
Aortic Valve Prolapse (TTE)
Aortic Valve Prolapse (TEE)
Aortic Root Disease Aortic dilatation related with - Hypertension - Age-related (degenerative) - Bicuspid AV Aortic dissection Cystic medial necrosis (Marfan syndrome) Takayasu arteritis Behcet’s disease Ankylosing spondylitis Less common - Syphilitic aortitis, psoriatic arthritis, UC, giant cell arteritis - relapsing polychondritis, Reiter syndrome
Effacement of the Sinotubular Junction Hypertension, Degeneration, Bicuspid AV
Aortic Dissection
Marfan Syndrome-I
Marfan Syndrome-II
Behcet’s Disease
Behcet’s Disease vs. Takayasu’s Arteritis JASE 2003;16:850
M-Mode AMVL fluttering in diastole Premature closure of MV and Diastolic opening of AV in severe AR
Estimating the Severity of AR Color Flow - Jet area/height - Vena contracta width - Flow convergence or PISA Continuous Wave Doppler - Signal density - Pressure half time (P½t) or Slope Pulsed Wave Doppler - Regurgitant volume/fraction - Descending aortic flow reversal 2D Echocardiography - LV end-diastolic dimension - LV end-systolic dimension
Color Flow Jet Area/Jet Height
Jet Area/Jet Height Instrument (gain) dependent, Eccentric Jet, Temporal variability Multiple jets or Jets with irregular shapes Color Flow
Vena Contracta Width (Semiquantification Method) Most narrow point : just below flow convergence reflect regurgitant orifice area Measure at zooming parasternal long axis view Vertical to AR jet : measure vena contracta width Color Flow
Vena Contracta Width (Semiquantification Method) Color Flow
Color Flow Flow Convergence or PISA Multiple measurements, Technically challenging AV calcification, Multiple jets, Aortic aneurysm, Limited experience
Continuous Wave Doppler CW Doppler Signal Density Qualitative Overlap between moderate and severe AR Aortic compliance, Blood pressure, LV size and compliance, etc An indicator of acuity rather than severity
Continuous Wave Doppler Mild Severe Diastolic Jet Deceleration
Pulsed Wave Doppler Descending Thoracic Aorta Abdominal Aorta Descending Aorta Holodiastolic Flow Reversal Aortic compliance Sample volume location
Pulsed Wave Doppler Regurgitation Volume and Fraction Aortic Regurgitant Volume = SVAV - SVMV Regurtitant Fraction = (Aortic regurgitant volume / SVAV) x 100
Pulsed Wave Doppler Regurgitation Volume and Fraction Require multiple measurements Assumes no regurgitation at reference valve Different stroke volume when atrial fibrillation exists
Quantification of AR Severity
Mild Moderate Severe Regurgitant jet width/LVOT diameter Regurgitant jet area/LVOT area PHT of CW Doppler signal Quantification of AR Severity
Acute versus Chronic AR
Acuity of AR Shape of AR on CW Doppler Premature Closure of MV Diastolic MR
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