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    Chapter 10 - Aortic Regurgitation

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    Oktorilla Fiskasianita
    This document discusses chronic aortic regurgitation, including its causes, hemodynamics, indirect findings, imaging and quantification of the aortic regurgitation jet, reference values for grading severity, and indications for surgery. Specifically, it covers topics such as: 1) Causes of chronic aortic regurgitation include degenerative aortic dilatation, congenital defects, post-endocarditis, and rheumatic aortic valve prolapse. 2) Hemodynamic findings include volume overload, dilated left ventricle, hyperdynamic filling pressure, and decreased afterload. 3) Imaging the aortic regurgitation jet can be done with 2D and Doppler ultrasound from multiple windows to

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    Chapter 10 - Aortic Regurgitation

    Uploaded by

    Oktorilla Fiskasianita
    39 views0 pages
    This document discusses chronic aortic regurgitation, including its causes, hemodynamics, indirect findings, imaging and quantification of the aortic regurgitation jet, reference values for grading severity, and indications for surgery. Specifically, it covers topics such as: 1) Causes of chronic aortic regurgitation include degenerative aortic dilatation, congenital defects, post-endocarditis, and rheumatic aortic valve prolapse. 2) Hemodynamic findings include volume overload, dilated left ventricle, hyperdynamic filling pressure, and decreased afterload. 3) Imaging the aortic regurgitation jet can be done with 2D and Doppler ultrasound from multiple windows to

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    This document discusses chronic aortic regurgitation, including its causes, hemodynamics, indirect findings, imaging and quantification of the aortic regurgitation jet, reference values for grading severity, and indications for surgery. Specifically, it covers topics such as: 1) Causes of chronic aortic regurgitation include degenerative aortic dilatation, congenital defects, post-endocarditis, and rheumatic aortic valve prolapse. 2) Hemodynamic findings include volume overload, dilated left ventricle, hyperdynamic filling pressure, and decreased afterload. 3) Imaging the aortic regurgitation jet can be done with 2D and Doppler ultrasound from multiple windows to

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views0 pages

    Chapter 10 - Aortic Regurgitation

    Uploaded by

    Oktorilla Fiskasianita
    This document discusses chronic aortic regurgitation, including its causes, hemodynamics, indirect findings, imaging and quantification of the aortic regurgitation jet, reference values for grading severity, and indications for surgery. Specifically, it covers topics such as: 1) Causes of chronic aortic regurgitation include degenerative aortic dilatation, congenital defects, post-endocarditis, and rheumatic aortic valve prolapse. 2) Hemodynamic findings include volume overload, dilated left ventricle, hyperdynamic filling pressure, and decreased afterload. 3) Imaging the aortic regurgitation jet can be done with 2D and Doppler ultrasound from multiple windows to

    Copyright:

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    Basics

    Cause of Chronic Aortic Regurgitation Cause of Chronic Aortic Regurgitation


    Degenerativ Aortic dilatation
    Congenital Postendocarditis
    Rheumatic Aortic valve prolaps
    Hemodynamics in AR Hemodynamics in AR
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!)
    Volume overload
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!)
    Dilated LV
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!)
    Hyperdynamic
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!) Filling pressure !/!
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!)
    Afterload !
    NOTE:
    An elevation of
    LVFP (diastolic
    dysfunction)
    usually denotes
    LV deterioration
    (symptoms!)
    Indirect ndings in AR Indirect ndings in AR
    Dilated LV Hyperdynamic function
    Eccentric LV hypertrophy Mildly enlarged LA
    MR (annular dilatation)
    Imaging and Quantication of AR Jet Imaging and Quantication of AR Jet
    NOTE:
    Look at Vena contracta
    and PISA! Use
    integrative approach
    to quantication.
    PLAX
    NOTE:
    Look at Vena contracta
    and PISA! Use
    integrative approach
    to quantication.
    PSAX (visualize origin of jet)
    NOTE:
    Look at Vena contracta
    and PISA! Use
    integrative approach
    to quantication.
    4 ch view/ 3 ch view
    NOTE:
    Look at Vena contracta
    and PISA! Use
    integrative approach
    to quantication.
    Suprasternal (to determine
    retrograde ow)
    NOTE:
    Look at Vena contracta
    and PISA! Use
    integrative approach
    to quantication.
    010 // Aortic Regurgitation
    1
    Aortic Regurgitation Reference Values
    Mild Moderate Severe
    Vena contracta < 3mm 3-6mm > 6mm
    Jet width (% of LVOT) < 25 2565 > 65
    Flow convergence
    (PISA)
    not visible small large
    PHT AR (msec) > 500600 200500 < 200
    Pitfalls Pitfalls
    NOTE:
    AR signal should
    have a vel. above 4,5
    m/sec! Otherwise
    signal quality is
    inadequate!
    Jet problems (complex,
    eccentric, multiple)
    AR CW signal
    problems
    NOTE:
    AR signal should
    have a vel. above 4,5
    m/sec! Otherwise
    signal quality is
    inadequate!
    Calcied valves
    Machine settings
    (PRF)
    NOTE:
    AR signal should
    have a vel. above 4,5
    m/sec! Otherwise
    signal quality is
    inadequate!
    Hemodynamic calculation of regurgitant volume and fraction
    SVMV = CSAMV x VTIMV = D
    2
    x 0.785
    SVLVOT = CSALVOT x VTILVOT = D
    2
    x 0.785
    010 // Aortic Regurgitation
    2
    Reference Values Mild Moderate Severe
    Regurgitant volume (ml/beat) < 30 3059 60
    Regurgitant fraction (%) < 30 3049 50
    PISA Method
    AR
    ow
    = 2! x r
    2
    x V
    r
    r = radius of ow convergence,
    Vr = corresponding aliasing velocity,
    Rvel = max. Vel of AR jet,
    ERO = efective regurgitant orice
    Reference Values Mild Moderate Severe
    ERO (cm
    2
    )
    < 0,1 0,10,29 0,3
    Acute Aortic Regurgitation
    Causes
    NOTE:
    LV Size = normal
    or mildly dilated
    and hyperdynamic
    Endocarditis
    NOTE:
    LV Size = normal
    or mildly dilated
    and hyperdynamic
    Cusp rupture
    NOTE:
    LV Size = normal
    or mildly dilated
    and hyperdynamic Aortic dissection
    NOTE:
    LV Size = normal
    or mildly dilated
    and hyperdynamic
    Iatrogenic (trauma)
    NOTE:
    LV Size = normal
    or mildly dilated
    and hyperdynamic
    010 // Aortic Regurgitation
    3
    Echofeatures of acute AR Echofeatures of acute AR
    Small/mildly dilated LV Tachycardia
    Initially hyperdynamic
    LV
    Holodiastolic retrograde
    ow (Ao. desc.)
    Short deceleration AR Premature MV-closure
    Indications for surgery
    Indication in symptomatic patients with severe AR
    Reduced LVF (LVEF < 50%)
    Dilated LV (LVEDD > 70mm LVES > 50mm (25mm/m2))
    If EF is too poor (< 30 35%) ! Heart
    transplantation
    010 // Aortic Regurgitation
    4

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