Aortic Regurgitation Flashcards
Infective endocarditis (a known cause of AR) may be associated with what?
Aortic root abscess.
Why does myxomatous disease cause AR?
Redundant leaflets sag in diastole.
What is the main cause of Ao root dilatation?
Hypertension.
What type of aortic dissection cause AR?
Type A
Type A dissections involve which part of the Ao?
The Ascending Ao.
Type B dissections involve which part of the Ao?
The Descending Ao.
True of False; Type B dissections cause AR.
False.
A common sign of AR is a collapsing pulse or a slow-rising pulse?
A collapsing pulse.
A common sign of AR is a low diastolic BP and wide pulse pressure, or a low systolic BP and a narrow pulse pressure?
A low diastolic BP and wide pulse pressure.
A common sign of AR is sustained apex beat or a displaced apex beat?
A displaced apex beat.
A sustained apex beat occurs as a result of what?
LVH
A displaced apex beat occurs as a result of what?
LV Dilatation.
What kind of murmur can be heard with AR?
An early diastolic murmur.
In terms of the LV, what are common echo findings with AR?
LV dilatation/impairment.
What can be seen on m-mode with AR?
High frequency fluttering of the aMVL as the AR hits it.
An diastolic Austin flint murmur can be heard with AR, what is this caused by?
Function MS due to AR.
The aMVL may show what in the presence of AR; and what might this cause?
Reverse doming and premature closure of the mitral valve.
Increased EPSS (E-point septal separation) can be seen in the presence of AR, what is this due to?
LV dilatation or because of restriction in opening of the aMVL due to the AR jet.
What parameters are used to assess AR severity?
End diastolic Velocity (upper DAo), Jet width/LVOT diameter, PHT, Regurgitant fraction, ROA, Regurgitant volume and Vena contracta.
What is considered severe for end diastolic Velocity (upper DAo)?
≥20cm/s
What is considered mild and severe for jet width/LVOT diameter?
Mild; <25%, Severe; ≥60%
What is considered mild and severe for PHT?
Mild; >500ms, Severe; <200ms.
What is considered mild, moderate and severe for regurgitant fraction?
Mild; ≤30%, Moderate; 31-49%, Severe; ≥50%.
What is considered mild, moderate and severe for ROA?
Mild; ≤0.10cm2, Moderate; 0.11-0.19cm2, Severe; ≥0.30cm*2.
What is considered mild, moderate and severe for regurgitant volume?
Mild; ≤30mL/beat, Moderate; 31-59mL/beat, Severe; ≥60mL/beat.
What is considered mild and severe for vena contracta?
Mild; <0.3cm, Severe; >0.6cm.
Where should jet width/LVOT diameter measurements be taken?
Just below (0.5-1cm of the level of) the AOV.
Measuring the width of the AR jet too far below the AOV can lead to an overestimation or underestimation of AR?
An overestimation.
Why can measuring the width of the AR jet too far below the AOV lead to an overestimation of AR severity?
Because the jet starts to “spread out”.
In what situation can jet width/LVOT diameter measurements be underestimated?
In eccentric jets.
True or false; vena contracta can or cannot be used in the presence of eccentric jets.
True.
How should vena contracta measurements be taken in eccentric jets?
Perpendicular to the direction of the jet.
When must vena contracta measurements not be used?
In the presence of multiple jets.
What may affect PHT calculations?
Changes in aortic and LV diastolic pressures.
A raised LV EDP will affect PHT how; and will it overestimate of underestimate the severity of AR?
PHT will shorten and the severity of AR will be overestimated.
True or false; PHT measurements are still valid in acute AR.
True.
With regards to end diastolic velocity (upper DAo), where should the sample volume be placed?
Just distal to the origin of the left subclavian artery.
What are the names of the three vessels that come off the Ao Arch (from left to right)?
Innominate Artery; Left Carotid Artery and Left Subclavian Artery.
With regards to the ECG, the end diastolic velocity (upper DAo) should be measured where?
At peak R wave.
Reverse doming of the aMVL and an Austin flint murmur (because of functional MS) are indicators of what?
More severe AR.
True or false; how far the AR jet extends back into the LV is a reliable indicator of severity.
False - it is unreliable.
Denser CW Doppler jets are seen in moderate/severe AR. Can density be used to distinguish moderate from severe AR?
No.
True of false; it is normal to see brief reversal of aortic flow in diastole in the suprasternal view.
True.
In the suprasternal view, what may indicate at least moderate AR?
PAN- OR HOLODIASTOLIC flow reversal (throughout the whole of diastole).
What may increase duration and velocity of flow reversal?
Reduced aortic compliance (with advanced age) and increased HRs.
Severe acute AR will show no end diastolic velocity, why?
Because flow reversal will decrease rapidly.
Pandiastolic flow reversal seen where is a specific indicator of severe AR?
In the abdominal Ao.
A VTI of diastolic flow reversal of what indicates severe AR?
> 15cm.
Calculation of regurgitant volume, regurgitant fraction and ROA is not appropriate when?
If there is significant coexistent mitral regurgitation (more than mild).
How is regurgitant volume calculated?
RV = SVlvot - SVmv
How is regurgitant fraction calculated?
RF = (RV/SVlvot) X 100
How is regurgitant orifice area (ROA) calculated?
ROA = RV/VTIar
True or False; the PISA method in the assessment of AR is not as common as it is for mitral regurgitation.
True.
Why is the PISA method in the assessment of AR is not as common as it is for mitral regurgitation?
It is technically more challenging and the technique has not been well studied in relation to the AOV.
Mild-moderate aortic regurgitation should have follow up scans how often?
Every 2-years.
Severe AR with normal LV function should have follow up scans how often?
Every 6months.
Dilated aortic roots should have follow up scans how often?
Annually; or even more frequently if the AO is enlarging.
What medications have a role to play in those with Marfan’s syndrome?
Beta-blockers.
Aortic valve surgery is indicated when?
- For symptomatic acute aortic regurgitation; 2. In severe symptomatic chronic aortic regurgitation; 3. In asymptomatic chronic aortic regurgitation with LV impairment, LV dilatation or if other heart surgery is required.
Regardless of AR severity, surgery is indicated for patients with aortic root dimensions of what, in Marfan’s syndrome?
≥4.5cm
Regardless of AR severity, surgery is indicated for patients with aortic root dimensions of what, with a bicuspid AOV?
≥5.0cm
Regardless of AR severity, surgery is indicated for patients with aortic root dimensions of what?
≥5.5cm
What parameters affect operative risk?
Right heart size and function, and PA pressures.
