defects causing stenosis/regurg

valvular anomalies

abnormal cusp #, abnormal cusp, annulus or supporting structure malformation can cause both stenosis and regurg

pulmonary stenosis is _____ common as a congenital defect than degenerative pulmonary stenosis

more

in all of the valves except pulmonary, _____ stenosis is more common

acquired

bicuspid aortic valve

valve composed of 2 cusps intead of 3, most commonly results from fusion of rt and left coronary cusps w larger anterior/smaller posterior

which cusp do the coronary arteries originate from in bicuspid aorta

anterior cusp

most common congenital heart defect found in adulthood

bicuspid aorta

how does a bicuspid aortic valve sound

systolic ejection click immediately after s1 sound

may be followed by a crescendo-decrescendo systolic murmur if stenosis is present

in bicuspid av, how do the leaflets look in systole

doming of leaflets (concave)

in bicuspid av, how do the leaflets look in diastole

hammock shaped (convex)

when must leaflet number be evaluate for bicuspid av

in systole, the valve may appear normal in diastole and fused raphe cannot be detected without the valve open

what is bicuspid av associated with

• ai

• coarctation

• dilated aorta

• marfan syndrome

what does screening look like for bicuspid av

• patients screened annually when asymptomatic, biannually w aortic dilation

• first degree family members should be screened for the defect

membranous subvalvular aortic stenosis

membranous band of tissue located in the lvot near the aortic valve, obstructing left ventricular ejection of flow and simulating aortic valve stenosis

membranous subvalvular stenosis is best evaluated in what view

apical 5 chamber

why can’t the continuity equation provide an accurate valve area

bc the obstruction is in the lvot

how is membranous subvalvular aortic stenosis best demonstrated

using pw doppler to demonstrate the increasing velocity as the cursor is moved along the lvot

cw doppler may be used for peak velocity at the defect once location has been documented w pw

what can membranous subvalvular stenosis cause in the heart

• compensatory left ventricular hypertrophy

• early systolic closure of the aortic valve that can be demonstrated on m mode

how is m mode used to differentiate the difference between subvalvular from valvular aortic stenosis

• elevated velocity + normal valve opening + early systolic closure = subvalvular

• elevated velocity + restricted valve opening = valvular

supravalvular aortic stenosis

narrowed aortic root

t/f: supravalvular aortic stenosis is uncommon

true, results from a congenital condition such as williams syndrome

what is supravalvular stenosis typically caused by in adults

abnormal fibrous tissue accumulation/inflammation (takayasu arteritis)

how does supravalvular stenosis appear on us

increased velocity in the affected segment w normal aortic valve motion

why won’t the continuity equation not provide the correct valve area

obstruction is in the aortic root and valve can demonstrate normal motion

what imaging modalities are useful in making a diagnosis for supravalvular aortic stenosis

ct/mr bc of the limited sonographic windows of the ascending aorta in some patients

types of aortic stenosis

aortic valve prolapse

normal aortic cusps coapt approximately halfway between the aortic annular base and the sinotubular junction, prolapse is diagnosed if a cusp demonstrates downward displacement below this level

aortic valve prolapse is most commonly seen in patients with

bicuspid av

aortic valve prolapse is also associated with

• aortic root dilation

• mitral valve prolapse

• severe mitral regurgitation

• outlet vsd

what will be present in cases of aortic prolapse

ai

cleft mitral valve

split or tear in one or both of the mitral valve leaflets, psax view most often shows a divison of the anterior leaflet, sometimes making the valve appear as though it has 3 leaflets

what is cleft mitral valve associated with

• partial atrioventricular septal defect

• primum asd

cleft mitral valve results in

mr

with cleft mitral valve, plax view will show

anterior mitral doming during systole, but there is no stenosis of the valve

parachute mitral valve

• congenital anomaly

• one papillary muscle attached to both sets of chordae

• usually the posteromedial muscle is the only one present

• presents like mitral stenosis on echo/doppler

double orifice mitral valve

• accessory orifice

• psax best to visualize

• flow eval may be normal or appear w signs of stenosis/regurg

how can a mitra-clip device and double outlet mv be differentiated from each other

note the echogenicity of the clip to differentiate

cor triatriatum

membrane across the mid portion of the left trium disrupts flow from atrium through mitral valve, membrane usually above the level of the fossa ovalis

how does cor triaatriatum look on us

suggests presence of 3 atrial chambers on 2d

can cause supravalvular stenosis

mimics mitral stenosis w turbulent flow, increased psv and ppg

dilated pulmonary veins

80% also have asd

can form in the right atrium as well but this is less common

supravalvular mitral stenosis

membrane or tissue thickening located at the level of the mitral annulus obstructs left ventricular inflow

what is supravalvular mitral stenosis associated with

asd

vsd

coarctation

persistent left svc

shone complex

mitral valve prolapse most often occurs as a _____ disorder

congenital

pulmonary vein stenosis

• narrowing of one or more pulmonary veins at their connection with the left atrium

• usually congenital

• difficult to diagnose w tte

what is seen w pulmonary vein stenosis

• pulmonary htn

• right ventricular hypertrophy

• right ventricle and atrial dilation

how does pulmonary vein stenosis look on doppler eval

• peak systolic velocity (s) and peak diastolic velocity (d) both increased

• flow reveral between systole and diastole