Regurgitation

Question 1

Aortic regurgitation

Etiology

Answer 1

AV
Acquired: rheumatic, calcific (+/-AS), endocarditis (vegetation, perforation), traumatic, toxin, radiation
Congenital: bi/quadri/uni cusp, VSD
Aorta
Acquired: aneurysm, dissection, autoimmune; SLE, Ankylosing spondylitis. Aortitis; syphilis, Takayasu’s, trauma
Congenital: Marfan, EDS

Question 2

AI

Types, by cusp motion

Answer 2

1. Normal cusp motion, coapts @ or above annulus in SOV
   subtypes:
   A) dilation of STJ
   B) dilation of SOV
   C) dilation of annulus
   D) cusp fenestration
2. Excessive cusp motion, cusp body falls below the AV annulus; prolapse or flail cusp
3. Restricted = central malcoaptation
   2/2 calcification or rheumatic

Question 3

AI

severity

Answer 3

Qualitative 
Jet width LVOT: small/int/ large 
Flow convergence: “.      “ 
CW density: faint / dense 
PHT: >500 / 200-500 / <200 
DescAo rev: early,brief /int/holo 
Semi quantitative 
VC (mm): < 3 / 3-6 / > 6 
Jet/LVOTcsa (%): <5 / 5-59 / >=60 
Jet/LVOTwidth (%): <25 / 25-64 / >=65
Quantitative 
Rvol (mL): <30 / 30-59 / >=60 
RF (%): 20-30 / 30-49 / >=50 
EROA: <0.1 / 0.1 - 0.29. / >= 0.3

Question 4

MR

Etiology

Answer 4

Trace MR is normal-ish (45% of PTs) 
Primary (structural)
Leaflet: degeneration, myxomatous, rheumatic, endocarditis, congenital 
Annulus: MAC 
Chordae: rupture, elongated, tethered 
Pap muscle: rupture 
Secondary (functional) 
-annular dilation 
-LV dysfunction (ischemic) 
-AS, SAM 
Diastolic MR: seen in severe AI, LVP exceeds LAP during diastole

Question 5

MR

Severity

Answer 5

Qualitative 
Color flow jet area: small/+_/large 
Flow converge(cm): <0.3/+_/>=1 
CW strength: faint/dense,partial/holo 
Semi quantitative 
VC (cm): <0.3 / intermediate/ >=0.7
PV (s-wave): norm/norm-blunt/reverse 
Mitral inflow: A-wave/variable/E-wave
Quantitative 
EROA: <0.2 / 0.2 - 0.39 / >= 0.4 
RV (cm^3): <30 / 30 - 59 / >=60 
RF (%): <30 / 30 - 49 / >= 50

Question 6

TR

etiology

Answer 6

Functional (normal leaflets)
-annular dilation
-papillary muscle dysfunction
-pressure/volume overload
-PAC cath (mild TR)
Structural
-Rheumatic; most common cause of TS but TR»TS (MV>AV>TV)
-Myxomatous
-Ensteins’s; large sail-like anterior leaflet w/ apical displacement of septal and posterior leaflet. assoc with secundum ASD and WPW/SVT
-Carcinoid; thickened and fixed leaflets, TR>TS also can effect PV
-Endocarditis

Question 7

TR

Severity

Answer 7

CWD jet density: soft / int / very dense

Jet area (cm2): <5 / 5-10 / >10

VC (mm): >7

HPV flow: S / S blunting / S reversal

Question 8

PI

Etiology

Answer 8

Mild PI = normal variant 
Significant PI is usually congenital 
Acquired is rare 
-Endocarditis (least common valve to be effected by endocarditis)
-carcinoid 
-Pulm HTN 
-Myxomatous 
-Radiation

Question 9

PI

Severity

Answer 9

Graded analogous to AI; jet area, width, holodiastolic reversal 
Jet length (mm): <10 / int / large, wide