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Echocardiographic Assessment of Valve Adapted from: Baumgartner H, Hung J, Bemleio J, Chambers JB, Evangelism A, Gnffin BP, lung B, Otto CM, Pellikka PA, Quir ione s M. 0( Valve Stenosis: EAEIASE Recommendations for Clinicai Practim. Assessment Echocardiographic Eur J Echocardiogr and J Am Soc Echocxardiogr 2009.
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M s m m m l o f w m Stenosis
Page 1 : # 6
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Findings indicative of hemodynamically signifi c a nt t ri cuspi d s t e nos i s
l
s p eci n c Findings
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l Ti/2
valve area by c ontinuity e qua tion
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supportive Findings Enlarged right atrium 2 moderate
Dilated interior vena cava
Stroke volum e derived from left or right ventricular outflow. in t h e presence of more t h an mild tricuspid regurgitation, the derived vatve area will be underestimated. Nevertheless u va lue s 1 c m’ imP lies a s''Q nificant hemodynamic burden Imposed b y t h e c om bine d lesion.
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Page 2 of 6
AS E
Am e r ic a n So ciety of
Ech o card io g rap h y
H m r r & Cirrululiwn l l l l m m u n d s peri al i s rs
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AS E
A merican S ociety of Ech o card io g rap h y
H a a r t & Circulation Ul t rasound Specialists
Measures of AS s everity obtained by Doppler-echocardiography Units
AS jet
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Page 4 of 6
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AS E
A m e ri c a n So ciety of
Ech o card io g rap h y
Data recording a nd measurement use fo r mltral ste nosls quantitation
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Echocardiographic Evaluation of LVDiastolic Function
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Adapted lrom. Nagueh SF. Appleton CP. Glllebert TC, Marino PN. Oh JK. Smlsetn OA, Waggener/XD, Flacnskampl FA, Recommendations for the Evaluation of Left Ventricular Dlastolrc Function by Echocardiography, Eur J Ecnocarcirogr an d J Am Soc Echocardiogr 2009
LVand LA Pressures in Normal a n d Abnormal Diastolic Function Normal EDP -_
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Echocardiographic Evaluation of LVDiastolic Function
Page 1 ot 8
AS E
A merican So ciety of Ech o card io g rap h y
H e u n sf Circulurion Ul rms o u n d s p n i a l i n x
Relation of Mitral Inflow and TD Veiocities with LVand LA Pressures pid Filling
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Differentiation of Constrictive Pericarditis from Restrictive Cardiomyopathy Constriction
Restriction
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Normal
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>1.5
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Mitral inflow resp irato ry variation Hepatic vein Do p p ler
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Echocardiographic Evaluation of LVDiastolic Function
P age 5 of 8
AS E
A m e r ic a n So ciety of
Ech o car d io g r ap h y
H eu rt 81Ci rcul at i on Ul t ras o u n d S pecialist:
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Echooartiographic Evalxation of LVDiaslolic Function
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Evaiudion of Prosthetic Vllhrn with Echocardiography and Dapplor Uiimmmnd
Adapied from Zughbi WA. Chambers JB, Dumesnrl JG, Foster E, Gottdiener JS. Grayburn PA, Khandheria BK, Levine RA, Marx GFI, Miiief FA, Nakatani S, Ouinones MA, Fiakowski H, Rodriguez LL, Swamrnathan M, WaggonerAD. Weissman NJ, Zabalgoiiia M, Recommendations for Evaluation oi Prosthetic Valves with Echocardiography and Doppler Ultrasound, J Am Soc Echocardxogr 2009 Sept. 22(9) 975-1014 This ASE guideline document was e ndor se d by the Arriencan Coliege ol Cardiology Foundation, Amencan Heart Association, European Association orEchocardiography. a registered branch oi European Society of Cardioiogy, Canadian Socieiy oi Echocardiography, an d J ap an es e Society oi Echocardiography.
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Clinical information
Imaging of the valve
Doppler echocardiography of the valve Contour of the jet velocity signal Peak velocity and mean gradient Velocity-time integral (VTI) of the jet Doppler velocity index (DVI) Pressure half-time (PHT) in mitral and tricuspid valves Effective orifice area (EOA) Presence, location, and severity v3;; of regurgitation with previous Comparison of above parameters 55,: Comparison helpful in suspected valvular post-operative study, dysfunction Qwhen available
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Aortic Valves
etic Aortic Valve Furlction in ad Biological Valves Normal
Peak velocity w
Mean gradient w Effective orifice area
P ossible S ie nosls
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specificity for normality or abnormality is seen il the majority ol the parameters listed are normal or abnormal, respectively. WSlightly higher cut-offs are seen in some bioprosthetic valves; these parameters are also abnormal in the presence of signiicant prosthetic mitral regurgitation. /
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Flow masking in mechanical valves from t h e transthoracic appr oach can hinder assessment of pr osthetic mitral regurgitation Transthoracic
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Findings Sugge st i ve of Significant Prosthetic Mitral Regurgitation by 'ITE in Mechanical Valves with Normal Pressure Half-time
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Peak mitral velocity 21.9m/s
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Systolic flow convergence seen in the LV towards the prosthesis
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Narrowing of forward color map
Peak velocity through the prosthesis > 3 rn/s, or > 2 mls through a homograft
Increase in peak velocity on serial
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Impaired RV function or elevated RVsystolic pressure
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H ear t Alt Circulation Ul l rasound Sp eci al i s t s
Guidelines for t h e Echocardiographic Assessment o f t h e Right Heart in Adults
Adapted lr om , Fiudski LG Lai WW. Afilalo J. Hua L Haridscriumaolier MD. Charidrasekarari K. Solomon S D , Louie EK. Schiller NB Guidelines ior the Echocardiograptirc Assessment ol the Right Heart in Adults A Report from the American Society ol Echocardiography J Arri Soc Echocardiogr 2 0 i 0 ; 2 3 ' 6 8 5 -7 1 3 .
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Poster ordering information an d lull text of ASE guideline d o c u m e n ts available at: www.asecho.org/guidelines The information on these pages doe s riot constitute the oiierlrig of medical advice by ASE. and should not be used as the sole basis to make medical practice decisions. illustration e` Copyright 2010 The American Society oi Echocardiography by me dmovie c om Design and
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Variable
Abnormal
A. RV Basal (RVD1)
> 4.2
cm
RV Mid (RVD2)
>
RV Longitudinal (RVD3)
> 8.6 cm
3.5 cm
B. RVOT PLAX proximal
>
3.3 cm
C, RVOT PSAX distal
>
2.7 cm
D. RV Wall T hicknes s
>
0.5 cm
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Tracing of the right atrium (RA) is performed from the plane of the tricuspid annulus (TA), along the interatrial septum (IAS), superior and antero-lateral walls of the RA. The RA major dimension is measured from the TA center to the superior RA wall, and the RA minor dimension is measured from the anterolateral wall to the IAS, as indicated by the yellow
Inferior vena cava (IVC) view. Measurement of the IVC. The diameter (solid line) is measured perpendicular to the long axis of the IVC at end expiration, just proximal to the junction of the hepatic veins that lie approximately 0.5-3.0 cm proximal to the ostium of the right atrium (RA).
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Abnormal
RA Major Dimension
>5.3 cm
RA Minor Dimension
>4.4 cm
RA End-Syslolic Area
>18 cm?
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TCO = Time from *closure to opening of tricuspid valve ET = Ejection time ICT = lsovolumetric contraction time IRT = Isovolumetric relaxation time ED = End-diastole ES = End-systole RVMPI = Right ventricular myocardial performance index
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Abnormal
Variable
A. TAPSE
<1_6 cm
B_ Pulsed Doppler peak velocity at the annulus (S')
<10 cm/s
C. FAC (%) DAPuised Doppler |v|P|
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mPAP = 4(Ear|y PI ve|ocity)2 + RAP '
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Abnormal 2 25mm Hg
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dPAP = 4(End Pr ve|ocny>2 + RAP
artery RAP = Right atrial pressure
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Estimation of RApressure Variable IVC diameter
the basis of IVC diameter and collapse
Normal Intennediate 5-10 (0-5 (3) mmHg) ( (8) mmHg) $2.1
cm
S 2.1
>50%
Collapse with sniff
High (15 mmHg)
cm >2.1 cm
<50%
> 2_1 Cm
>50%
<
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- Restrictive tilling -Tricuspid EIE’ >6 -Diastolic flow
Secondary indices of elevated RA
predominance in HV " Ranges are provided for low and intermediate categories; however, for simplicity, a mid-range value of 3 mmHg for “normal” and 8 mmHg for “intermediate” are suggested. Intermediate (8 mmHg) RApressures may be downgraded to normal (3 mmHg) if no secondary indices of elevated RA pressure are present, upgraded to high ifminimal collapse with sniff (<35%) and secondary indioes of elevated RApressure are present, or left as 8 mmHg if uncertain. lVC = Inferior vena cava; RA=Right atrium; HV= Hepatic veins
pressure
Normal
:§'|’:;;‘§§;n Pseudonormal
Restrictive
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<6
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>6
>120ms
>2.1
>6
<120ms
Diastolic flow predominance in HV Late diastolic antegrade flow in PA
Guidelines lor the Echocardiographic Assessment of the Right Heart in Adults
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Mild
Moderate
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Valve structure and motion Mechanical or Bioprosthetic Structural parameters
Usually normal
Abnormal iv
Abnormal ~v
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Norma'
Normal or mildly
Dilated o
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Doppler Parameters (Qualitative or Semi-
Quantitative) Jet width in central jets LVO diameter) - Color* Jet density - CW Jet deceleration rate (PHT, ms) - CW§ LVO flow compared to PW pulmonary flow Diastolic flow reversal in the PW descending aorta Doppler Parameters
-
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Regurgitant Volume Regurgilant Fraction
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Slow (> 500) Slightly increased Absent or brief early diastolic < <
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Intermediate,
(26% -64%) Dense Variable (200-500)
Intermediate Intermediate
-
30 59 ml/beat 30 50%
Large, (2 65%) Dense Steep
(<200) Greatly increased Prominent,
holodiastolic
3 60 ml/beat 3 50%
WAbnomiel mecnenloel valves; eg, immobile oocluder (valvular regurgitation), denisoenoe or rocking (paravslvular regurgitation); Abnormal biological valves: eg. Leatlet thickening or pmlapee (vat/utar), dehisoenoe or rocking (pafavalvular regurgitation)
° Parameter
applicable to oentraljets and is less accurate in eccentric jets; Nyquist limit ot 50-60 cmls lrmuenosd § by LVcompliance GtApplies to chronic, late postoperative ARIn the absence of other etlologles CW= continuous wave Doppler; LV= tell ventricle; LVO =left ventricular outflow tract; PHT = pressure halt-lime; PW= pulsed weve Doppler.
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Curbomodics Bileafiei
cnrwmar- sauna Stented biopmsfhesis
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partcardlal Stented Bioplusthesis
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29 31 33 27 29 31 33 27 29 31 33 27 29 31 33 27
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29 31 33 23 25 27 29 31 26
1.9
Pr assun lull-time (ms)
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1.72 0_4 1 6 2 0 .3
17 2 0.3
3.6 2 0.6
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1.61 20. 3 1. 52203
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Evaluation of Prosthetic Valves
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