DK2985_C000 1..28 - AlSharqia Echo Club

Mitral Valve 407Table 17.4BVR Echocardiographic Score Used to Predict Outcome of Mitral Valve ValvuloplastyGrade Mobility Subvalvular thickening Thickening Calcification0 Normal mobility No thickening Normal leaflet thickness No calcification1 Highly mobile valve withonly leaflets tips restrictedMinimal thickening justbelow the mitral leafletsLeaflets near normal inthickness (4–5 mm)A single area of increasedecho brightness2 Leaflet mid and base portionshave normal mobilityScattered areas of brightnessconfined to leaflet margins3 Valve continues to moveforward in diastole,mainly from the base4 No or minimal forwardmovement to the leafletsin diastoleThickening of chordalstructures extending upto one-third of thechordal lengthThickening extending to thedistal third of the chordsExtensive thickening andshortening of all chordalstructures extending downto the papillary musclesMidleaflets normal,considerable thickening ofmargins (5–8 mm)Considerable thickening ofall leaflet tissue (5–8 mm)Considerable thickening of allleaflet tissues (.8–10 mm)Extensive brightnessextending to themid-portion of the leafletExtensive brightnessthroughout much of theleaflet tissueNote: Each of the four characteristics is given a score from 0 to 4, and the BVR score is calculated as the sum of the four individual scores, with results thusranging from 0 to 16.examined. Spontaneous echo contrast (smoke) may beseen in the LA, particulary if the MVA is ,1.4 cm 2 .Its presence signals a very high risk for atrial thrombus(up to 60%) (45) and systemic embolism (46). Thecontractility of the left atrial appendage may also beassessed by pulsed-wave (PW) Doppler interrogation(Fig. 17.31) (47): when velocities are ,25 cm/sec, therisk of thrombosis is high.(A)(B)ASDLARARVAoVPA(C)Figure 17.29 (A, B) Mid-esophageal 488 view of an iatrogenic atrial septal defect (ASD) with a left-to-right shunt in a 69-year-oldman following transseptal catheterisation. (C) Intraoperative findings showing jet through the ASD (arrow) from a left atrial view (AoV,aortic valve; LA, left atrium; PA, pulmonary artery; RA, right atrium; RV, right ventricle). (Photo C courtesy of Dr. Michel Pellerin.)