Aortic Valve Flashcards

1
Q

Views of the aortic valve

A

ME AV SAX
•NCC nearest IAS
•RCC near origin of RCA
•LCC near origin of LCA

ME AV LAX
•RCC in far field
•NCC or LCC in near field
•measure LVOT, annulus, SoV, STJ, Asc Aorta

Deep TG LAX
•alignment of doppler beam parallel to blood flow
•calculate CO and AVA by continuity equation
•determine dimensionless index

TG LAX

ME 5C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathophysiology of aortic insufficiency

A

No isovolumetric phases
Higher EDVs and ESVs
EDP elevated in acute and decreases in chronic
Heart compensates by dilating and increases SV
Volume overload problem that compensates by dilating which eventually leads to chronic uncompensated when overdilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LV functional adaptations in AI

A

Acute —> increased pressure and volume

Chronic compensated —> dilation with increased SV with decreased RF

Chronic uncompensated —> overly dilated with decreased SV and increased RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TEE evaluation of AI

A
AI jet / LVOT diameter (ME AV LAX)
•>65%
AI area / LVOT area (ME AV SAX)
•>60%
Jet depth (ME AV LAX)
•papillary muscle
Vena contracta (ME AV LAX, ME AV SAX)
•>6mm width
•>7.5 mm^2 area
Slope of AR jet decay (Deep TG LAX, TG LAX)
•>3 m/s
Pressure Half Time
•<200 ms
•affected by multiple things — not the best or most reliable measure
Holodiastolic flow reversal descending thoracic aorta
Regurgitant volume
•>60 mL
Regurgitant fraction
•>50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prognosis of AI dependent on 3 factors

A

High Risk = definite surgery
Symptomatic
LV dysfunction (EF < 55%)
LV dilation (LVESD > 25 mm/m^2)
Dilation of ascending aorta
•sinus of valsalva measurement the best predictor (normal 25 - 31 mm)
•dilation > 50 - 55 mm replace regardless of level of AI

Low Risk Group
Ao ratio < 1.3 (measured / predicted sinus diameter — determined by age and size of patient)
•> 40 yo : 1.92+(0.74 x BSA)
•18-40yo: 0.97+(1.12 x BSA)
Annual rate of change < 5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should AV be replaced for AI?

A

Severe symptomatic AR

Asymptomatic with:
•severe chronic AR w/o aneurysm of the ascending aorta with:
LV ESD/BSA > 25 mm/m^2
EDD > 70 mm or
Resting LVEF < 55%

Chronic AR with aortic root dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aortic insufficiency classification

A
Type 1a — dilation of ascending aorta
Type 1b — dilation of annulus and SoV
Type 1c — dilation of annulus
Type 1d — perforation
Type 2 — prolapse
Type 3 — restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathophysiology of aortic stenosis

A

Pressure overload problem

During LV ejection there is a significant amount of pressure generated

LVEDP is also elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TEE Evaluation of AS

A
Peak velocity
•> 4 m/s
Mean pressure gradient
•> 50 mmHg
•best gradient to measure
Max pressure gradient
•> 70 mmHg
Dimensionless Index — VTI lvot / VTI av 
•< 0.25
•independent of patient size, no measuring LVOT radius
•Vpeak can be substituted for VTI
AVA
•< 1 cm^2
A/BSA
•< 0.6 cm^2/m^2
**for low gradient / low flow AS use the continuity equation or dimensionless index**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pressure Recovery re: AS

A

Peak instantaneous gradient with doppler > peak to peak gradient with catheterization

•overestimates the pressure gradient across the valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly