57. ā¢ Regurgitant doppler signal is a function of pressure
gradient between aorta and LV
ā¢ Mild AR āsmall increase in LVEDP-gradual decline and
flat deceleration slope
ā¢ Severe AR āLVEDP rises rapidly-rapid decline
58.
59.
60. ā¢ Suprasternal window-descending aortic flow profile
ā¢ Short period of low velocity flow reversal-normal
ā¢ Pan diastolic flow reversal with end diastolic
velocity>20cm/s
61.
62.
63. Calculation of R.Volume and R.fraction
ā¢ SV=CSAxVTI
ā¢ R.Volume=SV[lvot]-SV[mv]
ā¢ RF=R.Volume/SV[lvot]
ā¢ ERO=R.Volume/VTI[ARjet]
ā¢ R.V>60ml,RF>50%,ERO>0.3cmĀ² indicate severe AR
71. Classification of AS severity
(based on 2014 AHA/ACC Valvular heart disease guideline)
72. SEVERITY
ā¢ 1. Regurgitant jet width/LVOT diameter ratio greater than or equal to 60
percent
ā¢ 2. Vena contracta greater than 6 mm
ā¢ 3. Regurgitant jet area/LVOT area ratio greater than or equal to 60
percent
ā¢ 4. Aortic regurgitation pressure half-time less than or equal to 250 ms
ā¢ 5. Holodiastolic flow reversal in the descending thoracic or abdominal
aorta
ā¢ 6. Regurgitant volume greater than or equal to 60 mL
ā¢ 7. Regurgitant fraction greater than or equal to 50 percent
ā¢ 8. Effective regurgitant orifice greater than or equal to 0.30cm2
ā¢ 9. Restrictive mitral flow pattern (usually in acute setting)