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Week 9: Pulmonary Regurgitation > Pulmonary Regurgitation > Flashcards

Pulmonary Regurgitation Flashcards

1
Q

What is physiological regurgitation?

A

Minor or trace degrees of regurgitation (in otherwise normal heart)

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2
Q

What is pathological regurgitation?

A

Regurgitation caused by disease (abnormal degree of regurgitation)

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3
Q

What is organic PR?

A

Primary anatomical problem with the valve structure - abnormalities of the valve itself (intrinsic PV disease)

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4
Q

What is functional PR?

A

Occurs secondary to causes other than primary valve problem (e.g. diseases affecting RV and MPA leading to annular dilatation, but the PV is anatomically normal)

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5
Q

Common causes of functional PR?

A
  1. Pulmonary HTN
  2. PA dilatation
  3. RV infarct
  4. Congenital heart disease
  5. RV cardiomyopathy
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6
Q

Common causes of organic PR?

A
  1. Infective endocarditis
  2. Congenital lesions (e.g. post Tetralogy of Fallot repair)
  3. Iatrogenic causes (e.g. post pulmonary valvotomy)
  4. Other rare causes: trauma, carcinoid syndrome, rheumatic involvement
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7
Q

What are the Doppler clues to significant PR?

A
  1. Colour jet width
  2. CW intensity of PR signal
  3. Rapid deceleration slope
  4. Early termination of PR signal
  5. Diastolic flow reversal in branch PA
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8
Q

Significance of colour jet width in assessing PR severity?

A
  • How much of RVOT PR jet occupies during diastole
  • Wider PR jet = worse PR
  • Jet to annulus ratio
  • Vena contracta width
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9
Q

How to assess jet to annulus ratio in PR, and its significance?

A
  • Jet:annulus = B/A
  • A = PV annulus measured at hinge point (onset of QRS complex)
  • B = jet width measured at same level as RVOT (onset of QRS)
  • Severe PR when jet:annulus ratio ≥ 50%
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10
Q

What three regions need to be seen to accurately measure VC-W?

A
  1. Flow convergence
  2. Vena contracta
  3. PR jet
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11
Q

What is the vena contracta?

A
  • Narrowest neck of flow region at level of PV immediately below flow convergence area
  • Measured PSAX for PR: early to mid-diastole
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12
Q

Significance of VC-W in PR?

A
  • Limitation: significance of VC-W yet to be defined
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13
Q

Significance of intensity of CW PR signal in assessing PR severity?

A

Stronger signal = more severe regurgitation = more RBCs moving

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14
Q

Mechanism of CW mild PR trace?

A
  • PAEDP is high whilst RVEDP is low
  • As diastole progresses, diastolic gradient decreases as PA pressure declines and RV pressure rises as it fills with blood during diastole
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15
Q

Mechanism of CW severe PR trace?

A
  • RVEDP rises rapidly due to rapid increase in RV diastolic volume caused by severe PR = rapid decline in pressure gradient
  • PR signal can terminate before end-diastole meaning RV diastolic pressure = PV diastolic pressure (PR must be very severe)
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16
Q

Limitation of steep deceleration slope/early PR signal termination in severe PR?

A
  • Seen due to elevated RVEDP

- RVEDP can also be elevated due to poor RV compliance

17
Q

What is early PR signal termination?

A

Early PR termination if RV diastolic pressure = PV diastole pressure (PR needs to be very severe)

18
Q

Significance of rapid deceleration slope in PR?

A
  • Deceleration slope reflects pressure gradient between PA and RV in diastole
  • Measured by p1/2t
  • Severe PR when p1/2t < 100ms
  • PR Index (PRi)
  • Short slope and early termination of PR = marked elevation in RVEDP (could be due to severe PR or reduced RV compliance)
19
Q

What is the PR index and what is its significance?

A
  • PRi = B / A
  • B = PR duration
  • A = total diastolic period
  • Severe PR when PRi < 0.77
20
Q

Where is diastolic flow reversal seen in severe PR?

A
  • Seen from level of PA branches; may be seen on CFI but best appreciated by PW (sample volume placed within LPA/RPA)
  • Severe PA => diastolic flow reversal in RPA/LPA
21
Q

Doppler characteristics of “free PR”?

A
  • Short duration, low velocity jet (easily missed by CFI)

- Should be identified by CW Doppler

22
Q

What pressures can be derived from PR signal?

A
  1. Mean PAP

2. PAEDP

23
Q

Formula to calculate PAEDP?

A
  • PAEDP = 4V(end-PR)^2 + RVEDP

- In the absence of TS, RVEDP = RAP

24
Q

Formula to calculate mPAP?

A
  • mPAP = 4V(early-PR)^2 + RAP

Week 9: Pulmonary Regurgitation (2 decks)

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