DK2985_C000 1..28 - AlSharqia Echo Club

360 Transesophageal EchocardiographyTable 15.5Application of Specific and Supportive Signs, and Quantitative Parameters in the Grading of Aortic Regurgitation SeveritySpecific signs for AR severitySupportive signsMild Moderate SevereCentral jet, width ,25% ofLVOT aVena contracta ,0.3 cm aNo or brief early diastolic flowreversal in descending aortaSigns of AR . mildpresent but no criteriafor severe ARCentral jet, width 65% ofLVOT aVena contracta .0.6 cm aPressure half-time .500 msNormal LV size b Intermediate values Pressure half-time ,200 msHolodiastolic aortic flowreversal in descending aortaModerate or greater LVenlargement cQuantitative parameters dR vol, mL/beat ,30 30–44 45–59 60RF, % ,30 30–39 40–49 50EROA, cm 2 ,0.10 0.10–0.19 0.20–0.29 0.30a At a Nyquist limit of 50–60 cm/sec.b LV size applied only to chronic lesions. Normal 2D measurements: LV minor axis 2.8 cm/m 2 , LV end-diastolic volume 82 mL/m 2 (2).c In the absence of other etiologies of LV dilatation.d Quantitative parameters can help subclassify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.Note: AR, aortic regurgitation; EROA, effective regurgitant orifice area; LV, left ventricle; LVOT, left ventricular outflow tract; R vol, regurgitant volume;RF, regurgitant fraction. [With permission of Zoghbi WA et al. (39).]valve. There is no single golden echocardiographicmeasurement in the evaluation of valvular heart disease.Multiple techniques and views should be used to obtaina composite assessment of severity. Accurate echocardiographicevaluation and quantification of AoV pathologyare crucial in determining whether or not a patient willhave to undergo a surgical intervention. Detailed knowledgeof the aortic root anatomy not only allows the physicianto understand pathological echocardiographicfindings but also provides crucial information in the planningof the surgical procedure for the patient.ACKNOWLEDGMENTSSpecial thanks to Dr. Lawrence Rudski for reviewing thismanuscript and his expert advice.REFERENCES1. Netter FH, Yonkman FF, Ciba Pharmaceutical Company.Heart a compilation of paintings on the normal and pathologicanatomy and physiology, embryology, and diseases.Summit, N. J: CIBA Pharmaceutical Company, 1978.2. Cemri M, Cengel A, Timurkaynak T. Pentacuspid aorticvalve diagnosed by transoesophageal echocardiography.Heart 2000; 84:E9.3. Bonow RO, Carabello B, de LA Jr et al. Guidelines for themanagement of patients with valvular heart disease: executivesummary. A report of the American College ofCardiology/American Heart Association Task Force on PracticeGuidelines (Committee on Management of Patients withValvular Heart Disease). Circulation 1998; 98:1949–1984.4. Otto CM, Burwash IG, Legget ME et al. Prospective studyof asymptomatic valvular aortic stenosis. Clinical, echocardiographic,and exercise predictors of outcome. Circulation1997; 95:2262–2270.5. Keane MG, Wiegers SE, Plappert T et al. Bicuspid aorticvalves are associated with aortic dilatation out of proportionto coexistent valvular lesions. Circulation 2000; 102:III35–III39.6. Nistri S, Sorbo MD, Basso C, Thiene G. Bicuspid aorticvalve: abnormal aortic elastic properties. J Heart ValveDis 2002; 11:369–373.7. Quinones MA, Otto CM, Stoddard M et al. Recommendationsfor quantification of Doppler echocardiography: areport from the Doppler Quantification Task Force of theNomenclature and Standards Committee of the AmericanSociety of Echocardiography. J Am Soc Echocardiogr2002; 15:167–184.8. Baumgartner H, Stefenelli T, Niederberger J et al. “Overestimation”of catheter gradients by Doppler ultrasound inpatients with aortic stenosis: a predictable manifestation ofpressure recovery. J Am Coll Cardiol 1999; 33:1655–1661.9. Laskey WK, Kussmaul WG. Pressure recovery in aorticvalve stenosis. Circulation 1994; 89:116–121.10. Garcia D, Dumesnil JG, Durand LG et al. Discrepanciesbetween catheter and Doppler estimates of valve effectiveorifice area can be predicted from the pressure recoveryphenomenon: practical implications with regard to quantificationof aortic stenosis severity. J Am Coll Cardiol 2003;41:435–442.