PI

Question 1

Def of PI

Answer 1

incompetent PV allows backflow from PA → RV during diastole
o Normal finding in most species
o Rarely significant enough to be concerning

Question 2

Causes

Answer 2

o Normal
o PH
o Surgical procedure: balloon valvuloplasty
 Usually mild, w/o clinical sequelae
o Dilated PA
o Infective endocarditis
o Rheumatic heart disease, CT disease, carcinoid syndrome

Question 3

PE

Answer 3

diastolic murmur
o Uncommon
o Soft murmur in early to mid diastole
 Decrescendo or crescendo-decrescendo
 If from PH: louder, harsher and longer murmur duration
* Graham Steel’s murmur in Hu
o Usually also a soft systolic ejection murmur is also present

Question 4

Echo 2D findings

Answer 4

o Most common cause of PI = PA dilation → can be 2nd to
 Idiopathic
 Chronic PH, HW disease
 L to R shunting congenital anomaly (ie. PDA)
 PS
o Right sided volume overload: RVCH, RVEH, RAE
o Diastolic fluttering to TV

Question 5

Most common cause of PI

Answer 5

PA dilation → can be 2nd to
 Idiopathic
 Chronic PH, HW disease
 L to R shunting congenital anomaly (ie. PDA)
 PS

Question 6

Doppler findings

Answer 6

color flow
o Assessment of severity
 Jet length is not specific
* Can be affected by small changes in driving pressures
 Jet area correlates better
* Remains extremely variable
* Overlap btw severity grades
 No well established parameters → multiple parameters is useful

 Peak PI >2m/s → represents mean PAP
* End PI → diastolic PAP
* More severe PH can be indicated from
o Density of envelope
o Area of color Doppler jet
o Width of jet
o Prolonged ½ pressure time

Question 7

Other echo indirect signs of PH

Answer 7

• ↓PA AT + prolonged ET, ↓AT:ET ratio
• Flattened/paradoxical septal motion → ↑RV vs LV diastolic P
• ↓RPA distemsibility
• PA dilation
• Normal PA peak velocity