Aortic Regurgitation

Question 1

What are 4 groups of mechanisms that cause aortic incompetence (AI)?

Answer 1

Cuspal abnormalities, aortic root dilation, aortic root distortion, loss of commissural support

Question 2

Cuspal abnormalities includes what four things?

Answer 2

Congenital abnormalities, rheumatic aortic valve disease, aortic valve prolapse, infective endocarditis

Question 3

What are some examples of congenital abnormalities?

Answer 3

Bicuspid or quadricuspid AV

Question 4

What is quadricuspid AV associated with?

Answer 4

Anomalous coronary artery origin

Question 5

What is rheumatic AV disease associated with?

Answer 5

Aortic stenosis, mitral regurgitation, and mitral stenosis

Question 6

What is aortic bacterial endocarditis?

Answer 6

When vegetation destroys the AV

Question 7

What does aortic root dilation do?

Answer 7

Prevents normal leaflet coaptation during diastole which leads to AR

Question 8

What are six causes of aortic dilation?

Answer 8

1. Systemic hypertension
2. Atherosclerosis
3. Connective tissue disorders
4. Bicuspid AV
5. Sinus of valsalva aneurysms
6. Idiopathic dilation

Question 9

What happens with aortic root distortion?

Answer 9

Root becomes distorted due to inflammatory process

Question 10

Which inflammatory processes can lead to aortic root distortion?

Answer 10

Ankylosing spondylitis, takayasu’s arteritis, rheumatoid arthritis

Question 11

Loss of commissural support may occur with what three things?

Answer 11

Ventricular septal defects, aortic dissections, aortic trauma

Question 12

What are causes of acute severe AI?

Answer 12

Trauma, infective endocarditis, aortic dissection

Question 13

How does acute sever AI affect filling pressures?

Answer 13

They will be increased, especially LVEDp

Question 14

How does acute-severe AI increase EDP?

Answer 14

Regurg volume leaks back into the LV as well as the normal blood flow from the LA. Since it happens suddenly, the LV has not had time to stretch to accomodate for extra volume, therefore increasing pressure dramatically.

Question 15

Acute-severe AI may cause the early closure of the MV, why?

Answer 15

LV pressure rises faster than normal

Question 16

What would the filling pressures look like in someone with chronic-severe AI?

Answer 16

Normal or slightly elevated

Question 17

With chronic-severe AI, LV chamber size increases over time due to stretching. This may lead to what through the AV?

Answer 17

Increased forward volume

Question 18

Why would filling pressures appear normal in someone with chronic-severe AI?

Answer 18

Chamber sizes have had time to increase to accommodate for more volume

Question 19

In chronic-severe AI, the LV mass will increase, known as what kind of hypertrophy?

Answer 19

Eccentric

Question 20

What is one of the most common causes of acute severe AI?

Answer 20

Infective endocaditis

Question 21

What is an infective endocarditis?

Answer 21

Hypermobile mass on the underside of the AV

Question 22

The width of the vena contracta is less influenced by what?

Answer 22

Loading conditions

Question 23

What is jet height/LVOT ratio?

Answer 23

Measurement of jet height (LVOT level jet alias measurement in PLAX) divided by the LVOT

Question 24

What is is mild and severe jet height/LVOT ratio?

Answer 24

Mild = < 25%

Severe = ≥65%

Question 25

What is jet area/LVOT area ratio?

Answer 25

Trace of jet circle divided by trace of AV root circle in PSAX

Question 26

What is considered to be a mild and severe jet area/LVOT area ratio?

Answer 26

Mild = <5% Severe = > 60%

Question 27

What is considered a mild vena contracta?

Answer 27

<3 mm

Question 28

What is considered a severe vena contracta?

Answer 28

≥6 mm

Question 29

What would a bright signal indicate in terms of a waveform for AI?

Answer 29

More significant AI

Question 30

If flow reversal is seen in the abdominal aorta, what does this usually indicate?

Answer 30

Severe AI

Question 31

What does a steep slope indicate with pressure half time?

Answer 31

Severe regurg

Question 32

What are the mild, mod and severe pressure half time values?

Answer 32

Mild: >500 ms Mod: 200-500 Severe: < 200

Question 33

Why does severe AI have a steeper slope?

Answer 33

AI causes pressure in LV to rise faster than normal, this causes the pressure gradient between the LV and AO to drop faster = steeper slope.

Question 34

The stroke volume of a regurgitant valve will be higher than what?

Answer 34

The stroke volume of a normal valve

Question 35

How can you get regurgitant volume from stroke volume?

Answer 35

SV difference between a competent valve and a regurgitant valve.

Question 36

What is a quantitative method to assess AI?

Answer 36

PISA

Question 37

What does PISA stand for?

Answer 37

Proximal isovelocity surface area

Question 38

What is the formula for regurgitant volume?

Answer 38

RV = SVcompvalve - SVregurgvalve Or RV = CSAcv x VTIcv - CSArv x VTIrv

Question 39

What are the mild and severe values for regurg volume?

Answer 39

Mild < 30 mL | Severe >60 mL

Question 40

What is the AV regurgitant fraction?

Answer 40

RF(Ao) = ((SV(av) - SV(pv)) ÷ SV(av)) X 100

Question 41

What is considered a mild regurgitant fraction?

Answer 41

<30%

Question 42

What is considered a severe regurgitant fraction?

Answer 42

>50%

Question 43

What are two ways AI can affect the mitral valve?

Answer 43

1. AML doming (seen in PSAX) | 2. AML flutter

Question 43

What two things diagnose severe AI off the bat?

Answer 43

1. Vena contracta >6mm | 2. Reversal in desc Ao