TEE Flashcards
Normal Systolic LVID
Men: 32.4 +/- 3.7 mm
Women: 28.2 +/- 3.3 mm
Normal Diastolic LVID
Men: 50.2 +/- 4.1 mm
Women: 45 +/- 3.6 mm
Normal LVEDV
Men: 74 mL/m^2
Women: 61 mL/m^2
Normal LVESV
Men: 31 mL/m^2
Women: 24 mL/m^2
Relative Wall Thickness
(2 x PWT)/LVIDd
Concentric hypertrophy
RWT >0.42
Eccentric hypertrophy
RWT <0.42
Ejection Fraction
(EDV - ESV)/EDV
RV free wall thickness
End-diastole
<0.5 cm
RV dimensions
RVD1 (TV annulus): 2-2.8 cm
RVD2 (mid-ventricle): 2.7-3.3 cm
RVD3 (long axis): 7.1-7.9 cm
LA dimension
Men: 3-4 cm
Women: 2.7-3.8 cm
Volume: <34 mL/m^2
RA volume
Men: 25 +/- 7 mL/m^2
Women: 21 +/- 6 mL/m^2
Aortic Regurgitation
When to replace valve?
- Severe, symptomatic AR
- Asymptomatic patients with
- Dilated heart (EDD >70 mm)
- Decreased EF (<55%)
- Dilated aortic root (>50-55 mm)
Aortic Regurgitation
Pressure Half Time (PHT)
Mild: >500 ms
Moderate: 200-500 ms
Severe: <200 ms
Aortic Regurgitation
Deceleration Slope
Mild: <2 m/s
Moderate: 2-3 m/s
Severe: >3 m/s
Aortic Regurgitation
Descending Aorta Flow Reversal
Mild: Early brief
Moderate: Intermediate
Severe: Holodiastolic
Aortic Regurgitation
Vena Contracta width
Mild: <3 mm
Moderate: 3-6 mm
Severe: >6 mm
Aortic Regurgitation
AR Jet/LVOT width
Mild: <25%
Moderate: 25-64%
Severe: >64%
Aortic Regurgitation
Regurgitant Volume
Mild: <30 mL
Moderate: 30-59 mL
Severe: >59 mL
Aortic Regurgitation
Regurgitant Fraction
Mild: 20-30%
Moderate: 30-49%
Severe: >49%
Aortic Regurgitation
EROA
Mild: <0.1 cm^2
Moderate: 0.1-0.29 cm^2
Severe: >0.29 cm^2
Aortic Stenosis
Modified Gorlin Equation
AVA = CO / MG^(1/2) AVA = CO / PG
Aortic Stenosis
Peak Velocity
Aortic Sclerosis: = 2.5 m/s
Mild: 2.6-2.9 m/s
Moderate: 3-4 m/s
Severe: >4 m/s
Aortic Stenosis
Mean Gradient
Mild: <20 mmHg
Moderate: 20-40 mmHg
Severe: >40 mmHg
Aortic Stenosis
AVA
Mild: >1.5 cm^2
Moderate: 1-1.5 cm^2
Severe: <1 cm^2
Aortic Stenosis
Indexed AVA
Mild: >0.85 cm^2/m^2
Moderate: 0.6-0.85 cm^2/m^2
Severe: <0.6 cm^2/m^2
Aortic Stenosis Velocity Ratio (Dimensionless Index)
Mild: > 0.5
Moderate: 0.25-0.5
Severe: <0.25
LV Fractional Shortening
(LVEDd - LVESd) / LVEDd
Normal >25%
LV Fractional Area Change
(EDA - ESA) / EDA
Normal >40-45%
Ejection Fraction
(EDV - ESV) / EDV
Normal >55%
Simplified Bernoulli’s Equation
P = 4v^2
Dp/Dt
32/Dt
Normal >1200 mmHg/s
Abnormal <800 mmHg/s
Independent of afterload, dependent on preload
Velocity of Circumferential Shortening (VCF)
FS/LVET
Normal 1.09 +/- 0.3 circ/s
End Systolic Elastance
- Plot series of end-systolic points under various loading conditions
- Steeper slope = better systolic function
- Load independent
Preload-Recruitable Stroke Work
- Stroke work = area under pressure-volume loop
- Plot stroke work as function of end-diastolic volume
- Steeper slope = better systolic function
- Load independent
Preload Adjusted Max Power
=Stroke Work / (EDV)^2
=Stroke Work / (EDA)^(3/2)
-Load independent
Systolic Mitral Annular Velocity (Sm)
- S’ velocity lateral annulus
- Normal >8 cm/s
- Abnormal <5 cm/s
Strain Rate
= (v1-v2) / x
Dimensionless
Exempt from influence of translation
Load independent
Load Independent Measures of Systolic Function
- End-systolic elastance
- Preload recruitable stroke work
- Preload adjusted max power
- Strain rate
MAPSE
Normal 12 +/- 2 mm
Abnormal <8 mm
Myocardial Performance Index (MPI)
(ICT + IRT) / ET
Normal 0.39 +/- 0.05
Abnormal >0.5
Mitral valve annulus diameter
ME long axis view
Mid-diastole
29 +/- 4 mm
Mitral Regurgitation
Ajet/Aatria
Mild: <20%
Moderate: 20-40%
Severe: >40%
Mitral Regurgitation
Vena Contracta
Mild: <3 mm
Moderate: 3-6.9 mm
Severe: >7 mm
Mitral Regurgitation
MR Jet Area
Mild: <4 cm^3
Moderate: 4-10 cm^3
Severe: >10 cm^3
Mitral Regurgitation
Pulmonary Vein Flow
Mild: Normal
Moderate: Blunted S
Severe: S reversal
Mitral Regurgitation Regurgitant Fraction (RF)
RF = RV / SV(MV)
Mild: <30%
Moderate: 30-49%
Severe: >50%
Mitral Regurgitation Regurgitant Volume (RV)
RV = SV(MVinflow) - SV(LVOT) RV = EROA / VTI(MR) Mild: <30 cc Moderate: 30-59 cc Severe: >60 cc
Mitral Regurgitation
EROA
EROA = RV / VTI(MR) EROA(PISA) = Q(MRPisa) / V(MRpeak) Mild: < 0.2 cm^2 Moderate: 0.2-0.39 cm^2 Severe: >0.4 cm^2
Mitral Regurgitation
CWD Strength
Mild: Faint
Moderate: Moderate, partial
Severe: Very dense, holosystolic
Mitral Regurgitation
PISA Radius
If Valias = 40 and V(MRpeak) ~500 cm/s
Mild: <4 mm
Moderate: 4-10 mm
Severe: >10 mm
SAM Risk Factors
- LV EDD <45 mm
- Aortomitral angle <120
- C-sept distance <25 mm
- AL/PL <1.3 (valve closed)
- Basal septum >15 mm
- LVOT <2 cm
- AL length >2 cm (valve open)
- PL length >1.5 cm (valve open)
Mitral Stenosis
MVA by PHT
MVA = 220 / PHT
Mitral Stenosis
MVA by Deceleration Time
MVA = 759 / DT
Mitral Stenosis
Mean Gradient
Mild: <5 mmHg
Moderate: 5-10 mmHg
Severe: >10 mmHg
Mitral Stenosis
PHT
Normal: 40-70 ms
Mild: 70-150 ms
Moderate: 151-219 ms
Severe: >220 ms
Mitral Stenosis
MVA
Normal: >2.5 cm^2
Mild: 1.6-2.5 cm^2
Moderate: 1-1.5 cm^2
Severe: <1 cm^2
Mitral Stenosis
Peak PA Pressure
Normal: 20-30 mmHg
Mild: <30 mmHg
Moderate: 30-50 mmHg
Severe: >50 mmHg