Aortic regurgitation and diseases

What is Aortic Valve regurgitation?

•In this condition, the aortic valve doesn't close properly, causing blood to flow backward into the left ventricle.

Aortic Regurgitation is also called?

Aortic Insufficiency

What happens when a patient has (AI)?

Incompetent AOV that permits backward diastolic flow from the aorta into the left ventricle.

What type of murmur is heard with AI?

High-pitched, blowing, diastolic decrescendo murmur at left sternal border 

SEvere AI is called an

Austin Flint Murmur

What is AAO?

Acute aortic dissection, infective endocarditis, trauma

Chronic AI

AO dilatation, Aortic Stenosis

Bicuspid AV, incomplete closure, IE, RHD,

    Quad AOV

Treatment for AI

•Serial echos

•AOV repair or replacement

Echo findings for AI

Echo findings (2D, M-mode, CFD, & Doppler)

•Determine Mild vs severe AI

•Use P½t slope to measure the spectral waveform

Complications of AI?

•Over time, LV Volume Overload leading to LVD  & decreased LVFX & HF

• Increased risk IE

•CP

•Dizziness

•Exertional dyspnea

•Syncope

M-MODE findings

(5) AMVL diastolic flutter

 (6) severe, acute AR à sudden increase in preload à LVEDP > LAP so MV closes early &

(7) AOV opens early

 (8) normal AOV systolic flutter

(9) AR à closed cusps à abnormal AOV diastolic flutter

What views do we use color flow of the Aorta?

ALL VIEWS- PSLAX,APICAL 5 CH, SUPRA STERNAL, SAX AORTA, Apical 3 CH

Measure AI vena contracta in which view

The PLAX view>6mm is severe AI

With Aortic Regurgitation where do we place the CW cursor?

Through the AI JET

Aortic Regurgitation =

Antegrade flow

Measure PHT slope

Mild AR will have what waveform?

Flatter MS waveform and steeper AR Waveform.

Pressure diffrence gradually decreases and the AR slowly moves back through the closed AOV→LV

This creates a flatter Doppler waveform and a high Pressure Half time.

What will we see with severe AR?

Larger the defect, the faster the AO empties→ LV

The faster the AO pressure drops _> The steeper he LVP rises

This creates a steeper Doppler waveform and a LOWER pressure half time.

The steeper the slope the more

Severe AI is.

Mild AR grading

Pressure half time would be >500 ms

AR grading Moderate

Pressure half time 500 to 200 ms

AR grading Severe

Pressure half Time <200ms

If the regurgitation jet fills LVOT at a ratio:

<25% this suggests

mild regurgitation

If the regurgitation jet fills LVOT at a ratio:

<25 to 65% this suggests

moderate regurgitation

If the regurgitation jet fills LVOT at a ratio:

>65% This suggests

Severe regurgitation

The transducer is placed in the suprasternal notch

Angle inferior with the indicator towards the left ear sometimes 12 o'clock evaluate

Evaluate the Ascending

and Descending Aorta

For dilation, dissection,

coarctation & AI flow reversal

Normal Spectral Doppler waveform through the descending aorta is

retrograde

IF AORTIC REGURGITATION IS SEVERE IT WILL

BACKFLOW INTO THE DESCENDING AORTA AND APPEAR ABOVE THE BASELINE (ANTEGRADE)

•Coarctation of the aorta is considered a

A critical congenital heart defect

CoA defect occurs when

a baby’s aorta does not form correctly as the baby grows and develops during pregnancy

What does PREDUCTAL, JUXTADUCTAL, POSTDUCTAL mean?

above

At

Below

What does a dilated Aortic root entail?

Enlargement of the Ao root, abnormal balloon like bulge/dilatation anywhere along AO

The dilated aortic root may be associated with

underlying aortic valve abnormalities as seen with bicuspid aortic valve. It may also lead to the awareness of important underlying connective tissue disorders like the Marfan’s syndrome.

Why is it imperative that the dilated aortic root be observed?

It is imperative that the dilated aortic root be observed carefully over time with serial imaging studies and that timely resection of the aneurysm be carried out before catastrophic complications such as aortic dissection, aortic rupture, or congestive heart failure from aortic insufficiency occur.

a virtual ring that is formed by joining the imaginary distal attachments of the three aortic leaflets

The Aortic Annulus

Normal AORTIC PARAMETERS

An Aortic dissection is a serious condition in which

the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.

Risk factors of AI

oHTN

oatherosclerosis  

oAO aneurysm  

oBicuspid Aortic Valve (Bicuspid aortic valve (BAV) is associated with degeneration of the medial layer of the aorta) 

oAO coarctation

oconnective tissue disorder  

ochromosomal aberration

oinflammation/infection

opregnancy

otrauma

+ men, 60 – 80 years of age, cocaine use, extreme weightlifting

AO Dissection Signs and symptoms= Complications

Ehlers Danols Syndrome

Connective tissue disorder causing excessively elastic or stretchy skin and joints

Echo Findings include aortic root dilation, sinus of valsva aneurysm, bicuspid aortic valve, MVP, ASD and common atrium

Increased risk Aortic dissection

Aortic Dissection

The intima will detach from reaming layers of the wall allowing blood flow in the true and false

may involve aortic annulus causing acute aortic insuffiency

May involve one or both coronary artieries causing interription of conary flow and possibly an acute myocardial infraction

_______the preferred sonographic technique for evaluation of a potential dissection cardiovascular emergency

TEE

With Aortic Dissection _______is most commonly affected by shearing forces

The intima

With Aortic dissection, Aortic wall constantly subjected to forceful left ventricular ejection of blood during _____.

systole

Aortic Dissection Most commonly occurs

just distals to the origin of the left subclavian artery

associated with systemic htn blunt chest trauma, strenous activity, inflammotory disease

AO dissection

Patient usually experienes a painful ripping or tearing sensation in the chest when the dissection occurs, pain usually radiates to the _____

back

some congeitial disorders including _____, _______, and_______ carry increased risk of dissection

marfan syndrme, ehlers danols syndrome and turner syndrome

_________ usually demonstrates widening of the mediastinum

chest x ray