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The 3 regions of AO are:
- 1. Ascending AO
- 2. AO arch
- 3. Descending AO
The 3 layers of the AO are:
- 1. Tunica Interna
- 2. Tunica Media
- 3. Tunica Externa
Dimensions of the AO should be taken in _________________.
What 2 views should be done to obtain a compete echo examination (transthoracic)
Bicuspid AO valve 2D / M-Mode / Doppler appearance:
- 2D = thickened leaflet, football shape, systolic doming
- M-Mode = eccentric diastolic closure, LVH, LVE, LAE
- Doppler = AVA (continuity equation), AI, MR, measure for diastolic dysfunction
What is the most common congenital abnormality in an adult?
Bicuspid AO valve
Bicuspid AO valve ratio male:female =?
MC clinical symptom of bicuspid AO valve is ________________ on exertion.
dyspnea (labored breathing)
List the types of SUPRAvalvular AO stenosis: (4)
- 1. Hourglass
- 2. MMB
- 3. Strand (HLHS)
- 4. Coarctation
List the types of SUBvalvular stenosis:
- 1. Fibromuscular (tunnel)
- 2. MMB (collar)
- 3. DSAS=early closure of AV (closes in systole)
- IHSS (idiopathic hypertrophy subaortic stenosis) = mid closure of AV
- 4. LVH d/t LV pressure overload
Subvalvular Stenosis is aka:
discreet sub aortic stenosis
Define: coarctation of AO
Localized congenital narrowing of AO lumen
Doppler appearance of coarctation of AO?
Define: Marfan's Syndrome
Genetic disorder of connective tissue which runs in the family.
Echo appearance of Marfan's Syndrome:
Balloon shape--> loss of sinotubular jxn (leads to dissection)
Name & Describe the 2 classifications of AO dissections:
- 1. Debakery I (throughout AO), II(ascending), III(descending AO)
- 2. Stanford A(ascending AO), B(descending AO)
Echo appearance of sinus of valsalva aneurysm is?
Is there a difference in echo appearance with congenital sinus of valsalva aneurysm?
- Congenital = windsock - protrudes from AO sinus to adjacent cardiac structures; RCC MC affected (RVOT); may be associated with a fistula.
- Flow continuous unlike VSD where high flow seen in systole only
- Aquired - spherical, less irregular
Name the 3 types of AO aneurysms:
- 1. Fusiform
- 2. Sacular
- 3. Pseudo
What can give a false + for dissection?
venous flow adj AO arch = normal venous communication from SVC with flow toward the heart
What measurement do we use to quantify simple vs complex debris?
- < 5 mm = simple (no disruption of intimal surface)
- > 5 mm = complex (disruption of intimal surface)
Where is the AO isthmus?
Just below Lt Subclavian where arch meets descending AO
Dimensions of AO root are taken at ___________________.
Name the congenital diseases of AO valve: (5)
- Bicuspid valve
- Supravalvular stenosis
- Subvalvular stenosis
- Coarctation of AO
- Marfan's Syndrome
Supravalvular stenosis means:
narrowing of ascending ao
Subvalvular stenosis (discreet sub aortic stenosis) means
narrowing of the left ventricle just below the aortic valve
What syndrome is coarctation associated with?
Turner's (big chest, little legs, more flow in upper body)
In children coarctation is MC preductal / postductal?
In adults " " " "
What is BP before and after coarctation?
- increased before
- decreased after
What is the MC risk factor for AO dissection?
MC abnormality of AO is ____________________.
Most sever abnormality of AO is ____________________.