VALVULAR HEART DISEASE 2



valvular heart diseases too outline mutual Rieger tation tricuspid stenosis tricuspid regurgitation Epstein anomaly chaotic stenosis mutual Rieger tation m-mode lv level the left ventricle is dilated and hyperkinetic due to volume overload of LV the amplitude of motion of the IV septum and LV posterior wall is exaggerated in mr due to valvular disease 2d echo plaques view the left atrium is dilated and shows systolic expansion there is an increase in the Le posterior wall motion M mode mV level mutual valve leaflets show exaggerated excursion and quick MV closure due to rapid diastolic filling accordingly the de excursion of the AML is increased and the EF slope is steep there may be features of the underlying cause of mr such as MV prolapse or flail MV leaflet m-mode lv dimensions the left ventricular dimensions in and diastole and systole are increased if mutual Rieger tation is due to an allure stretching functional Emma left ventricular systolic function is impaired there may be eccentric LV hypertrophy which is inadequate for the degree of LV dilatation with an increased LV mass M mode a V level since a fraction of the stroke volume regurgitates into the left atrium there is mid-systolic closure of the aortic valve color flow mapping a reagent jet is seen in the left atrium on plaques view and a 4ch view the extent to which the mr jet fills the Le cavity indicates the severity of mr a turbulent jet with a Serling movement can cause systolic flow reversal in the pulmonary veins this retrograde flow along with normal Venice inflow sometimes gives a variance color map Doppler echo on CW Doppler scanning of the entire left atrium from the a4 CH view can detect the mr jet at any angle severity of mr is more closely related to the density or intensity of the flow signal a dense or intense signal indicates greater volume moving at high velocity by CW Doppler the pulmonary artery pressure can be estimated on PW da with the sample volume in a pulmonary vein retrograde systolic flow may be detected tricuspid stenosis m-mode and 2d echo features ii leaflets with or without calcification causing multiple reverberation echoes limited excursion of leaflets with restricted valve opening and slow diastolic closure flat EF slope diastolic dumbing of anterior tricuspid leaflet with paradoxical anterior motion of septal leaflet Doppler echo on PWD habla the T V inflow spectral trace shows an increased peak diastolic flow velocity exceeding 0.5 meter per second tricuspid regurgitation 2d echo AP for CH view the right ventricle is dilated and hyperkinetic due to volume overload it is of same size as or larger than left vertical when enlarged the right ventricle becomes globular and loses its normal triangular shape the right atrium is dilated and shows a systolic expansion with bulging of interatrial septum towards left atrium 2d echo SC 4 CH view the dilated right ventricle and right atrium can also be visualized from the subcostal for chamber view 2d echo plaques view the septum moves away from the left ventricle and towards the right ventricle in systole there is increased amplitude of motion of the RV free wall on m-mode scan at this level there is exaggerated leaflet excursion and early diastolic closure due to rapid diastolic filling 2d echo PS a X view the tricuspid valve can also be visualized from the short axis view at the aortic valve level it may reveal the underlying cause of tr such as rheumatic thickening leaflet prolapse flail leaflet valve vegetations color flow mapping in systole a mosaic colored reagent jet is seen in the right atrium are a along with interatrial septum the width of the tr jet correlates with the degree of regurgitated abroad color flow signal represents a severe TR on CW Doppler scanning of the entire right atrium from the a4 CH view can detect the TR jet a flow profile of high velocity with quick acceleration and rapid deceleration is an indicator of severe TR on PW Doppler mapping progressively deeper into the right atrium are a till flow is not seen can quantify the severity of TR on PW Doppler with the sample volume in the inferior vena cava retrograde a systolic flow may be detected abstain anomally to the echo a 4ch view there is downward displacement of the tricuspid valve into the body of the right ventricle the septal TV leaflet is attached to the IV septum 10 millimeter or more inferior to the anterior Mutual leaflet the anterior tricuspid leaflet is large and shows wide excursion with a whip like motion the right ventricle is small because its upper portion lies above the downward displaced tricuspid valve m-mode MV level closure of the TV is delayed and occurs more than 60 milliseconds after the MV closure do the echo PS ax view due to inferior displacement of the TV it is shifted clockwise from the normal 9 o'clock position to 11 o'clock Doppler echo pulse wave Doppler and color flow mapping can access the hemodynamic effects of tricuspid regurgitation and quantify the shunt across the atrial septum defect a artx genesis 2d echo plaques view in valvular a.s the aortic valve leaflets are thickened due to fibrosis with or without calcification in dramatic airs the process starts in the leaflets without fusion of comma shares followed by secondary calcification of the leaflets and analyst in calcific a.s the process starts with calcification of the analyst and progresses medially to involve the valve leaflets in bicuspid aortic valve calcification is observed only in the late stages of the disease there is reduced excursion of aortic leaflets with restricted opening of the aortic valve due to fusion at the leaflet tips and free motion of the leaflet bodies there is systolic dumbing this is a characteristic feature of rheumatic airs in valvular AAS there is post stenotic dilatation of the proximal aorta or aortic root in supra valvular is a thin linear echo discrete membrane extends in words from the aortic wall with an hourglass s there is a gradual decrease in a otic root diameter during above downwards angulation of the transducer in membranous sub chaotic s there is a linear echo in the LV outflow tract between the IV symptom and the ml of the mutual valve the linear echo is proximal and parallel to the aortic valve sometimes with a T artifact at its free edge in tunnel type sub erotic ears the left ventricular outflow tract is narrower than the aortic root in longstanding ears there is often left ventricular hypertrophy LVH due to left ventricular pressure overload there is thickening of the IV septum and LV posterior wall which exceeds 12 millimeter 2d echo PS ax view on short access view at a otic valve level there is leaflet thickening reduced excursion and a small AV lumen a bicuspid valve can be identified from this view m-mode av level normally on M mode scan from PL X view at the aortic valve level the aortic cusps from a central closure line is diastole in systole the open to form a box like opening or parallelogram shape in ES the closure line and the box like opening are replaced by multiple thick dense echoes in the aortic root throughout the cardiac cycle due to restricted leaflet excursion the size of the box like opening of the AV is reduced to less than 15 millimeter Doppler echo the normal peak chaotic systolic out flow velocity ranges from zero point nine to one point 8 meter per second with a mean of one point three meter per second in s the velocity exceeds two meter per second the peak velocity is obtained below or above the aortic valve level in sub valvular and Supra valvular a s respectively indications for intervention in Aires a stenotic chaotic valve and needs to be replaced by a prosthetic valve in the following situations a severe is pg greater than 64 millimeter hg AV area less than 0.75 centimeter square be moderate yes but with symptoms angina or syncope see moderate airs without symptoms but high activity level d moderate AAS with other cardiac surgery example CABG e moderate to severe AAS with LV systolic dysfunction

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