UN TRES JOLIE RESUME DES DIFFERENTS MESURES ECHO CARDIAQUE SELON BSE . Echocardiography: Valve Disease Assessment Authors: Liam Ring and Allan Harkness, David Oxborough, Bushra Rana, Kelly Victor, Abbas Zaidi, Daniel Knight, Luigi Badano, Patrizio Lancellotti, Sushma Rekhraj, Benoy Shah, Mark Belham, Keith Pearce, Sanjeev Bhattacharyya, Christophe Tribouilloy, Radwa Bedair, Daniel Augustine and Shaun Robinson. AORTIC REGURGITATION MITRAL STENOSIS

1. Echocardiography: Valve Disease Assessment
Authors: Liam Ring and Allan Harkness, David Oxborough, Bushra Rana, Kelly Victor, Abbas Zaidi, Daniel Knight, Luigi Badano, Patrizio Lancellotti, Sushma Rekhraj,
Benoy Shah, Mark Belham, Keith Pearce, Sanjeev Bhattacharyya, Christophe Tribouilloy, Radwa Bedair, Daniel Augustine and Shaun Robinson
MITRAL STENOSIS
Valve area∫∫ (cm²) 1.6–2.0 1.0–1.5 <1.0
Mean gradient (mmHg) <5 5–10 >10
Systolic PA pressure (mmHg) <30 30–50 >50
PULMONARY STENOSIS
Peak velocity (m/s) <3 3-4 >4
MITRAL REGURGITATION
Regurgitant orifice area (cm²) <0.20 0.20–0.39 ≥0.40†
Regurgitant volume (mL) <30 30–59 ≥60†
Regurgitant fraction (%) <30 30–49 ≥50
PISAr at Nyquist 40cm/s (cm) <0.3 0.4–1.0 ≥1.0
Vena contracta width (cm) <0.3 0.30–0.69 ≥0.7
Biplane VC width (cm) <0.3 0.30–0.79 ≥0.8
Pulmonary vein systolic flow Dominance‡ Blunting‡ Flow reversal
Dominant mitral inflow wave (cm/s) A-wave§ variable E-wave >1.5
MV inflow VTI/LVOT VTI <1 >1.4
Mitral leaflets Normal
Abnormal, flail, restriction, perforation
or wide coaptation defect
LV size (chronic primary MR) Normal
Dilated indicates severe primary MR,
although normal size does not rule
out severe MR
LA size (chronic primary MR) Normal Dilated
Jet area/LA (%) Small, brief 20–50 Large, >50
Flow convergence None, brief, small Intermediate Large & holosystolic
CW Doppler
Faint, partial,
parabolic
Intermediate
Similar in density to forward flow.
Triangular waveform suggests
torrential or acute severe MR
TRICUSPID REGURGITATION
EROA by PISA (cm²) <0.20 0.20–0.39 ≥0.40
EROA by 3D (cm²) >0.4
Regurgitant volume by PISA (mL) <30 30–44 ≥45
Colour flow area (cm²) <5 05–10 >10
Vena contracta width (cm) <0.3 0.3-0.69 ≥0.7
3D VC area (cm²) >0.4
PISAr at Nyquist 28 cm/s (cm) <0.5 0.5 - 0.9 >0.9
Hepatic vein flow Systolic dominance Systolic blunting Systolic flow reversal
TV E velocity Variable Variable More than or equal to 1 m/s
TV E/A ratio Variable Variable More than or equal to 1
Colour flow area/RA area (%) Small, narrow, central Large, >50%
Flow convergence zone Not seen/transient Intermediate Large holosystolic
CW Doppler signal Faint/partial/parabolic Variable contour
Variable – triangular
confirms severe
Tricuspid leaflets Normal, mildly abnormal
Severe lesions
(Abnormal, flail,
restriction, perforation or
wide coaptation defect)
RV size (chronic primary TR) Normal Normal
Dilated indicates severe
primary TR, although
normal size does not rule
out severe TR
RA size (chronic primary TR) Normal Normal Dilated
IVC diameter (cm) Variable Variable
<21 mm with >50%
inspiratory collapse is
unlikely in severe TR
AORTIC STENOSIS
Peak velocity (m/s) 2.5–2.9 3.0–3.9 4.0–4.9 ≥5.0
Mean gradient (mmHg) <20 20–39 40–59 ≥60
Valve area (cm²) >1.5 1.0–1.5 <1.0 ≤0.6
Valve area/BSA (cm²/m²) >0.85 0.60–0.85 <0.60
Velocity ratio >0.5 0.25–0.5 <0.25
MILD MODERATE SEVERE VERY SEVERE
AORTIC REGURGITATION
Regurgitant fraction (%) ≤30 31–49 ≥50
Regurgitant orifice area (cm²) <0.1 0.10–0.29 ≥0.30
Regurgitant volume (mL) <30 31–59 ≥60
Vena contracta width (cm) <0.3 0.3–0.6 >0.6
Jet width / LVOTd* (%) <25 25–64 ≥65
Jet CSA/LVOT CSA* (%) <5 5–59 ≥60
Dao end-diastolic velocity (cm/s) ≥20
Aortic leaflets
Normal or
abnormal
Abnormal, flail, restriction, perforation
or wide coaptation defect
LV size Normal
Usually dilated. May be normal in
acute severe AR
Jet width colour flow* Small Large
Flow convergence colour flow None/very small Large
Jet density CW Incomplete/faint Dense Dense
Pressure half time (ms) >500 200–500 <200
Diastolic flow reversal desc Ao Brief, early Intermediate Prominent holodiastolic
MILD MODERATE SEVERE
TRICUSPID STENOSIS
Mean pressure gradient (mmHg) ≥5
Pressure half time (ms) ≥190
Valve area by continuity (cm²) <1
PULMONARY REGURGITATION
Jet width/RVOT (%) >65
Vena contracta/PV annulus (%) <50 >70
Pressure half time (ms) <100
PR Deceleration time (ms) <260
Flow reversal Absent Absent
Flow reversal seen
within a PA branch
Doppler PR Index <0.77
* Central jets, variable in eccentric jets
† May be lower in secondary MR or when EROA is elliptical
‡ May be blunted in AF or LV dysfunction
§
E may be dominant in young or moderate+ diastolic dysfunction
∫∫
Valve area is a specific sign, others are supportive
Parameters of heart valve disease are affected by loading
conditions, blood pressure and heart rate. These should be
considered when diagnosing disease severity
Aortic
valve
Mitral
valve
Parasternal
LAX View
Parasternal RV View
Coronary Sinus
IVS seen
Parasternal RV View
No Coronary Sinus
No IVS seen
Coronary
Sinus
Septal
Anterior
Tricuspid
valve
Right
Coronary
Artery
Pulmonary
valve
Posterior
Regurgitatant orifice
circular
elliptical
Flow convergence (PISA)
Vena contracta
Jet expansion
Primary chords
Postero-
medial
commissure
Muscular mitral annulus
Aorto-mitral continuity
Antero-
lateral
commissure
Secondary chords
Tertiary chords
A3
P3 P1
A2
P2
A1
coaptation
LA
≤ 2mm above annular plane
TYPE 1
ANNULAR DILATATION
TYPE 2
LEAFLET PROLAPSE
Normal Mitral valve
TYPE 3
LEAFLET RESTRICTION
symmetrical coaptation zone
Assymetrical
coaptation zone
Prolapse of leaflet body
Loss of apposition
Failure of coaptation
Failure of coaptation
MR jet directed centrally
DCM
Severe LA dilatation
Degenerative
Mitral Valve Prolapse
Inflammatory Type 3a
Ischaemic Type 3b
MR jet directed contralateral MR jet directed ipsilateral
Flail segment Restriction of leaflet
5mm
Ring L, et al. Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography. Echo Res Pract. 2021 Apr 28;8(1):G19-G59. Robinson S, et al. The assessment of mitral valve disease: a guideline from the British Society of Echocardiography. Echo Res Pract. 2021 Sep 27;8(1):G87-G136. Zaidi, A, et al. Echocardiographic assessment of the
tricuspid and pulmonary valves: a practical guideline from the British Society of Echocardiography, Echo Research and Practice, 7(4), G95-G122. Zoghbi WA, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance.
J Am Soc Echocardiogr. 2017 Apr;30(4):303-371. Lancellotti P, et al. Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013 Jul;14(7):611-44.
The production of this poster has been made possible thanks to the sponsorship of GE and Philips
RIGHT HEART
MILD MODERATE SEVERE
LEFT HEART
BSECHO A1 Native Valve Assessment 30 Mar 22 v12.indd 1
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