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