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Echo 2 > Module 5 : Aortic Valve Regurgitation > Flashcards

Module 5 : Aortic Valve Regurgitation Flashcards

1
Q

what is another name for aortic regurgitation

A
  • aortic insufficiency/ incompetence
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2
Q

definition of AI

A
  • blood moves backward through the AV from aorta to the left ventricle
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3
Q

4 groups of mechanisms that can cause AI

A
  • cusps abnormalities
  • aortic root dilation
  • aortic root distortion
  • loss of commissural support
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4
Q

4 causes of cuspal abnormalities

A
  • congenital abnormalities
  • rheumatic aortic valve disease
  • aortic valve prolapse
  • infective endocarditis
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5
Q

3 types of congenital abnormalities

A
  • bicuspid AV and quadrucuspid AV
  • quadricuspid AV is extremely rare
  • quad is also associated with anomalous coronary artery origin
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6
Q

rheumatic AV disease characteristics

A
  • cusp tissue is infiltrated with fibrous tissue causing them to shorten
  • prevents cusps apposition easing to AI
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7
Q

what is rheumatic disease also associated with

A
  • aortic stenosis
  • mitral regurge
  • mitral stenosis
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8
Q

aortic valve prolapse characteristics

A
  • defined as cusp leaflet tips displaced below the valve ring
  • may be due to myxomatous degeneration fo the valve due to rheumatic heart disease
  • occur secondary to aortic root dilation or trauma
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9
Q

aortic bacterial endocarditis characteristics

A
  • vegetation destroys the AV

- cause perforation of cusps

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10
Q

what is aortic root dilation

A
  • prevents normal leaflet computation during diastole which leads to AR
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11
Q

6 causes of aortic root dilation

A
  • systemic hypertension
  • atherosclerosis
  • connective tissue disorders (marfans)
  • bicuspid AV
  • sinus of valsalva aneurysms
  • idiopathic dilation
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12
Q

what is aortic root distortion

A
  • root becomes distorted due to inflammatory process
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13
Q

what is aortic root distortion related to what 3 things

A
  • Ankylosing spondylitis
  • takayasu’s artitis
  • rheutmoid arthritis
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14
Q

3 things that loss of commissural support may occur with

A
  • ventricular septal defects
  • aortic dissections
  • aortic trauma
    + motor vehicle accident
    + fall from great height
    + blow to the chest
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15
Q

causes of acute-severe AI

A
  • trauma
  • infective endocarditis
  • aortic dissection
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16
Q

what does acute - sever AI causes what

A
  • increase in filling pressure mainly end diastolic pressure
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17
Q

how does acute - severe AI cause increase filling pressure

A
  • regurgitant volume leaks back into the LV as well as the normal blood flow from the LA
  • because it is acute the LV has not had time to stretch to accommodate the extra volume
  • LVEDP increases dramatically
  • cause early closure of MV (filling from both LA and AR jet)
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18
Q

chronic - severe AI characteristics

A
  • filling pressures may be normal or slightly elevated
  • RV caused the LV chamber volume to increase over time due to stretching
  • may lead to increased forward volume through the AV
  • volume entering the LV has increased from the RV but the chamber has dilated to try to accommodate it
  • leads to near normal filling pressures
  • LV mall will increase
  • LV may start to fail at which time the LVEDP will increase
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19
Q

6 symptoms of AI

A
  • dizziness
  • syncope
  • fatigue
  • SOBOE
  • CHF signs
  • auscultation
    + murmur
    + S3 and S4
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20
Q

complications with AI

A
  • increased LV and LA size from pressure overload
    + pulmonary venous congestion
    + pulmonary edema
    + right heart failure
    + systemic venous congestion and edema
  • embolization
    + sudden death
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21
Q

4 jobs for echo with AI

A
  • determine etiology = congential, degenerative, rheumatic
  • assess LV size and function
    + acute AI = filling pressure increased
    + chronic AI = has the dilated LV started to decompensated
  • measure aortic dimension
    + where is the aortic root dilated
    + annulus, sinus, STJ or ascending
  • estimate severity of AI
    + quantitative and semi quantitative
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22
Q

determining the etiology - quadracuspid AV

A
  • diagnosis made is PSAX view
  • look for X or + sign
  • rare
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23
Q

bicuspid AV and AI

A
  • jet is eccentric (off to one side)
  • ascending AO may be dilated
  • AI severity is progressive
  • younger patients have mild AI
  • gets worse as patient ages and aortic root dilates
  • can lead to chronic and severe AI
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24
Q

infective endocarditis and AI

A
  • one of the most common causes of acute and severe AI
  • hypermobile mass on UNDERSIDE of AV
  • different echo characteristics than surrounding tissue
  • causes AI by the infection destroying one or more of cusps
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25
Q

VSD and AI

A
  • membranous VSD’s are located just on the LV side of the AV

- can affect the supporting structure of the aortic root leading to AI

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26
Q

aortic root dilation and AI

A
  • dilates the aortic root will not allow the cusps to close tight
27
Q

aortic dissection and AI

A
  • dissection in the proximal portion of the aorta will cause some AI
28
Q

3 AI assessment methods

A
  • 2D assessment
  • color doppler assessment
  • spectral doppler assessment
29
Q

2D assessment metod

A
  • LV size
  • LV thickness
  • LV function
  • aortic root measurements
30
Q

color doppler assessement method

A
  • jet height ratio
  • jet area ratio
  • vena contracta
31
Q

spectral doppler assessment

A
  • AI jet intensity
  • flow reversal
  • AI pressure half time
  • regurgitant volume
  • regurgitant fraction
  • effective regurgitant orifice area
32
Q

2D assessment of LV size, wall thickness, function

A
  • with chronic volume overload such as significant AI = the LV progressively dilates
  • the LV will dilate until ultimately fails
  • LV start to look more spherical
  • ** measure LVEDD and LVESD and EF
  • calculate LV mass and assess for eccentric hypertrophy
33
Q

2D assessment - aortic root measurements

A
  • leading to leading edge
  • measure perpendicular to central aortic axis
  • reduce gain/ TGC with zoom
34
Q

what is jet height

A
  • JH
  • slightly on the LVOT side of the AV
  • not as accurate for severity of AI with eccentric jets
35
Q

what is vena contracta width

A
  • VC W
  • width of venal contract is less influenced by loading conditions
  • measure at most narrow point
  • use zoom to measure
36
Q

jet height / LVOT diameter

A
  • ratio between AI jet height diameter and LVOT diameter
37
Q

mild jet height / LVOT ratio

A

< 25%

38
Q

severe jet height / LVOT ratio

A

> /= 65%

39
Q

jet area / LVOT area ratio

A
  • performed at PSAX AV zoom
  • measure within 1cm of vena contracta
  • estimates regurgitant orifice area
  • may be over or underestimated based on direction of jet
40
Q

mild jet area / LVOT area ratio

A

< 5%

41
Q

moderate jet area / LVOT area ratio

A

5-56%

42
Q

severe jet area / LVOT area ratio

A

> 60%

43
Q

AI vena contracta

A
  • aka vena contracta zone
  • slightly smaller than jet diameter at valve
  • preformed in PLAX with zoom
  • narrowing of jet on LV side
  • best for single central jets
44
Q

mild AI vena contracta

A

< 3mm

45
Q

severe AI vena contracta

A

> /= 6mm

46
Q

what is AI jet intensity

A
  • density/brightness of AI jet is proportional to number of RBC moving in unison
  • brighter signal = more significant AI
47
Q

flow reversal in aorta from SSN

A
  • use color to visualize flow
  • PW in descending ao
  • look for retrograde flow in descending ao
  • should be holo diastolic
48
Q

what grade of AI is it if abd ao is reversed

A

severe

49
Q

what is pressure half time

A
  • PHT or P 1/2
  • the time it takes for the pressure to reduce by half of original
  • measures deceleration rate
50
Q

what is the pressure alf time determined by

A
  • pressure gradient
51
Q

steep slope more or less severe

A

more

52
Q

mild AI PHT

A

> 500ms

53
Q

moderate AI PHT

A

200-500ms

54
Q

severe AI PHT

A

< 200ms

55
Q

mild RV amount

A

< 30ml

56
Q

severe RV amount

A

> 60ml

57
Q

what is the PISA method to assess AI

A
  • proximal is-velocity surface area method

- measure mushroom cap

58
Q

what is the regurgitant fraction

A
  • percentage of blood leaking back across the valve
59
Q

RF for aortic valve equation

A

SVav - SVpv / SVav x 100

60
Q

mild RF

A

< 30%

61
Q

severe RF

A

> 50%

62
Q

mild effective regurgitant orifice area (PISA)

A

< 0.1

63
Q

severe effective regurgitant orifice area (PISA)

A

> /= 0.3

64
Q

other AI findings in 2D and Mmode

A
  • AML reverse doming / decreased AML excursion from AI jet

- AML flutter on Mmode

Echo 2 (18 decks)

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