echocardiographic assessment of aortic regurgitation
DESCRIPTION
ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC REGURGITATION. 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 - PowerPoint PPT PresentationTRANSCRIPT
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ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC
REGURGITATION
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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)
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• Regurgitant jet height measured as maximal diameter of regurgitant jet just below AV,PLAX view
• LVOT diameter in end diastole
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Regurgitant jet width/LVOT diameter ratio greater than or equal
to 60 percent
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Vena contracta greater than 6 mm
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• Regurgitant jet area measured from PSAX view at level of LVOT
• LVOA measured at end diastole at same site
• Ratio calculated
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• 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
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• Suprasternal window-descending aortic flow profile
• Short period of low velocity flow reversal-normal
• Pan diastolic flow reversal with end diastolic velocity>20cm/s
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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
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Restrictive mitral flow pattern
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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
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MILD MODERATE SEVERE
Reg vol < 30 ml >/= 60 ml
Reg fraction < 30 % >/= 50%
ERO < 0.1 cm2 >/= 0.3 cm2
Mitral inflow restriction
Present
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Extent of jet
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Signal intensity
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ACUTE VS CHRONIC
• Shape of the envelope CW doppler• Rate of deceleration of flow• Premature mitral valve closure • Endocarditis,dissection• Normal lv dimensions
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• LV chamber dimensions• LV systolic function• Aortic root dilatation
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Thank you