Echo assesment of Aortic Stenosis and Regurgitation
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Transcript of Echo assesment of Aortic Stenosis and Regurgitation
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ECHOCARDIOGRAPHIC ASSESMENT OF AORTIC VALVE DISEASES
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Aortic stenosis: Classification based on location
Valvular-most common type.
Subvalvular.
Supravalvular.
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Valvular Aortic Stenosis: Etiology
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Aortic Sclerosis
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Bicuspid Aortic Valve
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Bicuspid Aortic Valve
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Congenital Anomalies Of AV valve
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Calcific Aortic Stenosis of trileaflet valve
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Rheumatic aortic stenosis
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Subvalvular aortic stenosis
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Supravalvular aortic stenosis
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Echocardiographic assessment of severity
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Doppler assessment of AS
(EAE/ASE Recommendations for Clinical Practice 2009).
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Classification of AS severity(based on 2014 AHA/ACC Valvular heart disease guideline)
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Peak transvalvular velocity measurement
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Peak transvalvular velocity
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Peak transvalvular velocity
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Mean transvalvular gradient
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Mean transvalvular gradient
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Sources of error for pressure gradient calculations
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Sources of error for pressure gradient calculations
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Aortic valve area Continuity equation
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Aortic valve area Continuity equation
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Advantage of the Continuity Equation over Peak velocity Pressure gradient
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Pitfalls of the Continuity Equation
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Pitfalls of the Continuity Equation
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Low-flow low-gradient AS
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Low Dose Dobutamine Stress Echo-Protocol
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Low Dose Dobutamine Stress Echo
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Effects of concurrent conditions on assessment of severity
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Effect of LVH
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Effect of LVH
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Effect of Hypertension
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Effect of Aortic Regurgitation
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Effect of Mitral valve disease
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M Mode- Aortic Stenosis
DeMaria A N et al. Circulation.Suppl II. 58:232,1978
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ECHOCARDIOGRAPHIC ASSESSMENT
OF AORTIC REGURGITATION
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MILD MODERATE SEVERE
Jet width/LVOT
diameter
<25% >/=65%
Vena contracta <3mm >/=6mm
Jet area/LVOT
area
<5% >60%
PHT >500 ms </= 250ms
Holodiastolic
flow reversal
present
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MILD MODERATE SEVERE
Reg vol < 30 ml >/= 60 ml
Reg fraction < 30 % >/= 50%
ERO < 0.1 cm2 >/= 0.3 cm2
Mitral inflow
restriction
Present
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AR – VC, Jet width / Lvot width
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• Regurgitant jet height measured as maximal diameter of
regurgitant jet just below AV,PLAX view
• LVOT diameter in end diastole
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Regurgitant jet width/LVOT diameter ratio
greater than or equal to 60 percent
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Vena contracta greater than 6 mm
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AR – Jet area / Lvot area
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• Regurgitant jet area measured from PSAX view at level of
LVOT
• LVOA measured at end diastole at same site
• Ratio calculated
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AR – Pressure Half Time
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• Regurgitant doppler signal is a function of pressure
gradient between aorta and LV
• Mild AR –small increase in LVEDP-gradual decline and
flat deceleration slope
• Severe AR –LVEDP rises rapidly-rapid decline
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• Suprasternal window-descending aortic flow profile
• Short period of low velocity flow reversal-normal
• Pan diastolic flow reversal with end diastolic
velocity>20cm/s
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Calculation of R.Volume and R.fraction
• SV=CSAxVTI
• R.Volume=SV[lvot]-SV[mv]
• RF=R.Volume/SV[lvot]
• ERO=R.Volume/VTI[ARjet]
• R.V>60ml,RF>50%,ERO>0.3cm² indicate severe AR
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Restrictive mitral flow pattern
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Extent of jet
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Signal intensity
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Classification of AS severity(based on 2014 AHA/ACC Valvular heart disease guideline)
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SEVERITY
• 1. Regurgitant jet width/LVOT diameter ratio greater than or equal to 60 percent
• 2. Vena contracta greater than 6 mm
• 3. Regurgitant jet area/LVOT area ratio greater than or equal to 60 percent
• 4. Aortic regurgitation pressure half-time less than or equal to 250 ms
• 5. Holodiastolic flow reversal in the descending thoracic or abdominal aorta
• 6. Regurgitant volume greater than or equal to 60 mL
• 7. Regurgitant fraction greater than or equal to 50 percent
• 8. Effective regurgitant orifice greater than or equal to 0.30cm2
• 9. Restrictive mitral flow pattern (usually in acute setting)
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THANK YOU..