Echo assessment of aortic valve disease

1. ECHOCARDIOGRAPHIC
ASSESMENT OF AORTIC VALVE
DISEASES

2. Aortic stenosis: Classification based on
location
Valvular-
most common type.
Subvalvular.
Supravalvular.

3. Valvular Aortic Stenosis: Etiology

4. Aortic Sclerosis

5. Bicuspid Aortic Valve

6. Bicuspid Aortic Valve

7. Congenital Anomalies Of AV valve

8. Calcific Aortic Stenosis of trileaflet valve

9. Rheumatic aortic stenosis

10. Subvalvular aortic stenosis

11. Supravalvular aortic stenosis

15. Echocardiographic assessment
of severity

17. Doppler assessment of AS
(EAE/ASE Recommendations for Clinical Practice 2009).

18. Classification of AS severity
(based on 2014 AHA/ACC Valvular heart disease guideline)

19. Peak transvalvular velocity measurement

21. Peak transvalvular velocity

22. Peak transvalvular velocity

23. Mean transvalvular gradient

25. Mean transvalvular gradient

26. Sources of error for pressure gradient
calculations

27. Sources of error for pressure gradient
calculations

28. Aortic valve area Continuity equation

30. Aortic valve area Continuity equation

32. Advantage of the Continuity Equation over Peak
velocity Pressure gradient

33. Pitfalls of the Continuity Equation

34. Pitfalls of the Continuity Equation

35. Low-flow low-gradient AS

36. Low Dose Dobutamine Stress Echo-
Protocol

37. Low Dose Dobutamine Stress Echo

39. Effects of concurrent conditions on
assessment of severity

40. Effect of LVH

41. Effect of LVH

42. Effect of Hypertension

43. Effect of Aortic Regurgitation

44. Effect of Mitral valve disease

45. M Mode- Aortic Stenosis
DeMaria A N et al. Circulation.Suppl II. 58:232,1978

46. ECHOCARDIOGRAPHIC ASSESSMENT
OF AORTIC REGURGITATION

47. MILD MODERATE SEVERE
Jet width/LVOT
diameter
<25% >/=65%
Vena contracta <3mm >/=6mm
Jet area/LVOT
area
<5% >60%
PHT >500 ms </= 250ms
Holodiastolic
flow reversal
present

48. MILD MODERATE SEVERE
Reg vol < 30 ml >/= 60 ml
Reg fraction < 30 % >/= 50%
ERO < 0.1 cm2 >/= 0.3 cm2
Mitral inflow
restriction
Present

49. AR – VC, Jet width / Lvot width

50. • Regurgitant jet height measured as maximal diameter of
regurgitant jet just below AV,PLAX view
• LVOT diameter in end diastole

51. Regurgitant jet width/LVOT diameter ratio
greater than or equal to 60 percent

52. Vena contracta greater than 6 mm

53. AR – Jet area / Lvot area

54. • Regurgitant jet area measured from PSAX view at level of
LVOT
• LVOA measured at end diastole at same site
• Ratio calculated

56. AR – Pressure Half Time

57. • Regurgitant doppler signal is a function of pressure
gradient between aorta and LV
• Mild AR –small increase in LVEDP-gradual decline and
flat deceleration slope
• Severe AR –LVEDP rises rapidly-rapid decline

60. • Suprasternal window-descending aortic flow profile
• Short period of low velocity flow reversal-normal
• Pan diastolic flow reversal with end diastolic
velocity>20cm/s

63. Calculation of R.Volume and R.fraction
• SV=CSAxVTI
• R.Volume=SV[lvot]-SV[mv]
• RF=R.Volume/SV[lvot]
• ERO=R.Volume/VTI[ARjet]
• R.V>60ml,RF>50%,ERO>0.3cm² indicate severe AR

65. Restrictive mitral flow pattern

69. Extent of jet

70. Signal intensity

71. Classification of AS severity
(based on 2014 AHA/ACC Valvular heart disease guideline)

72. SEVERITY
• 1. Regurgitant jet width/LVOT diameter ratio greater than or equal to 60
percent
• 2. Vena contracta greater than 6 mm
• 3. Regurgitant jet area/LVOT area ratio greater than or equal to 60
percent
• 4. Aortic regurgitation pressure half-time less than or equal to 250 ms
• 5. Holodiastolic flow reversal in the descending thoracic or abdominal
aorta
• 6. Regurgitant volume greater than or equal to 60 mL
• 7. Regurgitant fraction greater than or equal to 50 percent
• 8. Effective regurgitant orifice greater than or equal to 0.30cm2
• 9. Restrictive mitral flow pattern (usually in acute setting)

73. THANK YOU..