Pathology Protocol

Question 1

Aortic Stenosis Measurements: AVA

Answer 1

LVOT diameter
CW AV
PW LVOT

Question 2

Aortic Stenosis: AVA

Bicuspid Valve - What else should you look for?

Answer 2

Look for coarctation

Question 3

Aortic Stenosis: AVA

Prosthetic Valve - additional measurement

Answer 3

DOI (dimensionless index)

LVOT (PW) VTI/CW AV VTI
A DOI of <0.25 on an AVR or MVR is indicative of an abnormally functioning valve

Question 4

Aortic Regurgitation

Answer 4

PLAX - LV color flow to show ratio of color flow jet to LVOT diam

SAX - ratio of regurg jet & regurg

Measure pressure half time

PW ascending aorta — Regurg moderate or more

Question 5

MV Stenosis

Answer 5

CW MV
Trace MV (MV TVI)
Pressure half time

Question 6

MV regurgitation

Answer 6

Qualitative ratio of color flow jet to LA size

PISA if >mild (cannot be done if there is sig AI or multi jet MR)

Question 7

PISA

Answer 7

CW + Trace: MR jet (MR VTI)
Small color box (over “mushroom”) and zoom on color box
Reduce baseline color: 0.2 “alias velocity”

MUSHROOM: radius of MR jet (top mushroom —> leaflets)
measure Vena contracta (dia color flow at narrowest through leaflets)
measure MV diameter (annulus opening as MV opens)
PW Doppler “MV VTI”

Question 8

Tricuspid Stenosis

Answer 8

CW TV
Trace TV (mean + peak gradient)

Question 9

Tricuspid Regurgitation

Answer 9

Qualitative ratio of jet to RA

CW TR — measure peak velocity

PW hepatic veins

Question 10

Pulmonic Stenosis

Answer 10

Veolcities >1.5m/s

CW PV
Trace PV velocity (mean + PG)

PW entire stretch of PA + PV (determines if subvalvular, valvular, or supravalvular)

Question 11

Pulmonic Regurgitation

Answer 11

Qualitative assessment

Severe PI — short decel time for jet

Question 12

PHTN

Answer 12

PW RVOT (pulmonary notching)

Observe/look for septal flattening

Measure RV diam (4C at annulus)

TDI

Measure IVC

Question 13

Tamponade/Restriction/Constriction

Answer 13

Measure:
largest pocket/s of fluid
pericardium if thickened

PW:
MV + TV inflow (slow speed to show E wave)

M-mode + 2D:
look for paradoxical septal motion (inspiration bounce of the septum)

Measure:
IVC (largest)

M-mode:
IVC
RV
RA

Question 14

Diastolic Function

Answer 14

Measure:
E/A wave
decel time
Valsalva E/A
LA volume
LV wall thickness
TDI:
Lateral wall
Septum

Question 15

HCM or dynamic gradient

Answer 15

M-mode & 2-D LV wall thickness

Measure:
Peak velocity (dagger): label “REST”
PW: entire LV & label APEX, MID, LVOT (note: location of obstruction, wave will go back to normal after obstruction)
CW: through gradient and have patient “VALSALVA”