ECHO

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Author:
liukuf
ID:
94597
Filename:
ECHO
Updated:
2011-07-19 22:05:29
Tags:
VHD
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VHD
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  1. Mean gradient for moderate Mitral Stenosis
    5-12 mmHg
  2. Mean gradient for severe MS.
    >12mmHg
  3. ERO severe AR
    >29 mm2
  4. ERO moderate MR
    0.20 - 0.29 cm2
  5. ERO mild MR
    <0.20 cm2
  6. ERO severe MR
    >0.40 cm2
  7. ERO mild AR
    <0.10 cm2
  8. ERO moderate AR
    0.10 - 0.30 cm2
  9. Mild AR deceleration rate
    <2.0 m/sec2
  10. Moderate AR decelerstion rate
    2-3.5 m/sec2
  11. Severe AR deceleration rate
    >3.5 m/sec2
  12. P1/2t severe AR
    <=200 msec
  13. P1/2 t moderate AR
    200-500 msec
  14. P1/2 t moderate AR
    >= 500 msec
  15. Normal PVar
    3-5 m/s
  16. Normal PVmr
    4-6 m/s
  17. Normal PVtr
    2.5 m/s
  18. Normal PVpr
    >=1.5 m/s
  19. AR jet/ LVOT diameter ratio for moderate AR
    25-64%
  20. AR jet / LVOT area ratio for moderate AR
    5-59%
  21. Moderate MR
    1-1.5 cm2
  22. Mild MR
    1.5-2.5 cm2
  23. Predictors of SAM post MV repair
    • 1. Coaptation to septal distance (C-Sept) >2.6 cm
    • 2. Post MV leaflet height > 1.5 cm.
    • 3. AL/PL ratio < 1
    • 4. Aortic MV angle < 130
  24. MVA calc by DT
    • 220/PHT
    • 220/0.29 x DT
    • 759/DT
  25. Severe MR parameters
    • ROA >= 0.4 cm2
    • RF >= 50 %
    • RV >= 60 ml
    • VC >= 0.7 cm
  26. Mild MR parameters
    • ERO < 0.20 cm2
    • RF < 30%
    • RV < 30 ml
    • VC < 0.3 cm
  27. Parameters severe AR
    • Jet Width/LVOT >65%
    • VC >0.6 cm
    • PHT <= 200 msec
    • RV >60 mL
    • RF >50%
    • ROA >0.30 cm2
  28. Parameters mild AR
    • Jet width/LVOT <25%
    • VC <0.3 cm
    • PHT >=500 msec
    • RV <30 mL
    • RF <30%
    • ROA < 0.10 cm
  29. Calc PVR in woods units
    • PVR= MPP−LAP / Qp
    • MPP=PADP+ 1/2 ×(PASP−PADP)
  30. Normal PVR in woods units
    • 1-2 woods units
    • >9 woods units precludes sx
  31. Normal SVR in woods units
    11-16 woods units
  32. What is estimated mean gradient in patient with AV PFV 5 m/sec
    The mean aortic valve gradient (ΔPmean) is approximately 60% of the peak gradient (ΔPmax):
  33. Severe TR may have low peak velocity (T or F)
    True. severe tricuspid regurgitation (low peak velocity; rapid deceleration slope due to rapid pressure equilibration between RV and RA)
  34. Signs of severe TR
    VC
    CW doppler
    Hep Vein
    • VC > 7 cm
    • Density of TR CW doppler = to antegrade flow
    • Reversal of systolic flow in Hepatic Vein
  35. Right sided volume overload without obvious ASD warrents TEE to look for?
    • Sinus Venosus ASD
    • Partial Anomalous PV return
  36. Continuous wave doppler characteritics MR vs AR.

    1. Jet Starts immediately after QRS.
    2. Midsystolic MR
    • 1. MR
    • 2. MVP
  37. What is pressure half time of stenotic MV if peak velocity is 2 m/sec.
    • Velocity at which gradient is 1/2 max velocity.
    • PHT=Max Vel/1.4 (msec)
  38. TV leaflets from parasternal SAX.
  39. Septal. 0%-48%
    • Anterior. 0%-52%
    • Posterior 92%-0%
  40. TV leaflet from A4.
    • Septal 0-100%
    • Anterior 100-0%
    • Posterior 0-0%
  41. TV leafletPatasternal RV inflow
    • Septal 100-0%
    • Anterior 0-100%
    • Posterior 0-0%
  42. Severe TR is mean gradient > ?
    • • Mean gradient via CW Doppler
    • - < 2 mmHg is normal
    • - > 7 mmHg is severe
    • - measure in held expiration
  43. TV area by PHT
    • • TV area = 190/PHT
    • - ≥ 190 msec is severe
  44. ACC Guidelines for Valvotomy
    • • Class I
    • - symptomatic patients with cath gradient ≥ 30 mmHg
    • - asymptomatic patients with cath gradient ≥ 40 mmHg

    • • Class IIb
    • - may be reasonable in asymptomatic patients with cath gradients 30 – 39 mmHg

    • • Class III
    • - valvotomy not indicated for cath gradients < 30 mmHg
  45. Patient Prosthesis Mismatch is defined as ERO corrected for BSA of
    • <=0.85 cm2/m2
    • Severe <=0.65
  46. How can you differentiate high AV gradient of functional (PPM/high CO) vs pathologic obstruction.
    AV Doppler evelope for functional obstruction will be pointy indicating normal accel while pathologic will be rounded.
  47. Findings indicating prothsthetic MV dysfxn of severe Mech MR
    • Mitral E>=1.9
    • normal p1/2 t >=130
    • MVR/LVOT TVI ratio >=2.2
    • Other
    • Increased mean grad
    • Decreased IVRT
    • Dense MR cw
    • PISA on LV side

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