Mitral Valve Pathology Flashcards
normal mitral inflow
during diastole
normal flow pattern is biphasic w/ E and A peaks
how is the spectral doppler labeled
D-E-F-A-C
what does the E wave represent
early diastole
passive filling
what does the A wave represent
atrial contraction
diastasis
when the pressures are practically equal, happens in mid diastole
in what views is MV flow evaluated
PLAX/PSAX
apical 4,3,2
what is deceleration time
the rate of deceleration of the pressure gradient between the LA and the LV, measured as the E-F slope
MV. peak velocity should not be greater than
1.5 m/s
what is cw for MV used to calculate
the mean gradient by performing a VTI trace of the spectral waveform above the baseline
what is pressure half time?
the time needed for the initial pressure gradient to fall to half of its value
-measure another e-f slope
also used for MV area in MS
normal PHT for MV
30-60 msec
when is the LV pressure much higher than the LA
during systole
what do we use to measure MR
CW doppler
color doppler for MR
turbulent with possible aliasing
mild mr
Mr jet just beyond the MV Leaflets
moderate MR
will fill up LA 1/3
severe MR
will fill up LA mid to back wall of LA
3/3
PISA
Blood converging on the regurgitant orifice can be seen as an isovelocity hemisphere of color. The area of this hemisphere is directly related to the volume of blood flow entering the regurgitant orifice.
how to calculate the PISA
- VTI trace
- radius of MR jet with color
- aliasing velocity
PISA for MIld MR
less than .5m
Vena contracta for moderate MR
.5 to .7cm
pisa for severe MR
greater than .8cm
pisa volumetric method
- only used when multiple MR jets are present
1. flow across the mitral valve calculated by the product of the area of the MV annulus and VTI of the MV PW
2. lvot calculated
3. regurgitant fraction calculated
2 major consequences of MS
- the LA does not empty completely, LV maintains higher pressure than normal
- pressure in the LA falls very slowly during diastole, E-F slope is diminised
what is the planimetry
manual tracing of the MV area in PSAX
mild MS mean gradient
less than 5 mmHg
mild MS mean gradient
<5 mmHG
severe MS mean pressure gradient
greater than 10 mmHg
MS pressure half time equation
220/pht
normal MVA
4-6 cm squared
mitral stenosis on M MODE
Anterior motion of PMVL due to stenosis
causes of MS
rheumatic fever
MAC
MV atresia
prosthetic valve
lupus etc
Equation for calculating MVA
MVA=220/PHT (pressure half time)
The greater the pressure half time in a stenosis…
The more severe
how do you adjust the color flow doppler for PISA
shift the baseline down to approx. 20-40 cm/s
EROA EQUATION
effective regurgitant orifice area= 2pie(PISAr)2 x Va (aliasing velocity) / MRVmax
MR volume equation
MR volume= EROA x MR vti
mild MR EROA
<.20
severe MR EROA
> .40
severe MR pulomary vein assesment
S wave reversal
D wave increased
MVP causes
connective tissue disorder
hereditary
assoc. heart abnormalities
in who is MVP more prevalent
women under 40
complications of MVP
MR
infective endocarditis
embolic events
ruptured chordae
severe ms PHT
> 220
mild ms pht
90-150
severe MR volume
> 60
mild MR volume
<30
