1. Functional or secondary 2. Organic or primary causes 3. Mechanical causes

C11: TV And PV Regurg Flashcards by M B

3 subgroups of TR

Functional or secondary
Organic or primary causes
Mechanical causes

How well did you know this?

Not at all

Perfectly

How do functional causes of TR cause regurg

what can cause this

by causing annular dilation, usually the TV leaflets have normal structure

dilated cardiomyopathy
ASDs
pulmonary hypertension

How well did you know this?

Not at all

Perfectly

How do organic causes of TR cause regurgitation

By causing disorders of the TV complex

How well did you know this?

Not at all

Perfectly

Possible causes of mechanical TR

Pacemaker leads

Implantable cardioverter debrillator leads

How well did you know this?

Not at all

Perfectly

If rheumatic is affecting the TV, are other valves often affected

Which other valves are usually affected

Yes, it rarely occurs it isolation w/ only the TV

MV and/or the AV

How well did you know this?

Not at all

Perfectly

US appearance of TV w/ rheumatic

Where does the thickened go start

Thickened and retraction of TV leaflets
TV diastolic doming (stenosis)
Dilation of the TV annulus (causes regurgitation)

Leaflet tips

How well did you know this?

Not at all

Perfectly

Describe TR due to carcinoid HD

Causes

Rare malignant neuroendocrine tumor that secretes excessive amount of serotonin w/ damages right heart valves

How well did you know this?

Not at all

Perfectly

US of TV w/ carcinoid

TV becomes thickened, retracted and rigid

You’ll see both stenosis and regurg…. value remains in a fixed, semi-open position, throughout the cardiac cycle

How well did you know this?

Not at all

Perfectly

Key difference b/w carcinoid and rheumatic

Involvement of the MV/AV w/ rheumatic…. with carcinoid the PV will be involved and left heart if not effected

How well did you know this?

Not at all

Perfectly

Why is the TV more susceptible to injury than the MV

RV is easier to compress making the Tv more susceptible

How well did you know this?

Not at all

Perfectly

What type of TR does trauma cause

Acute TR

How well did you know this?

Not at all

Perfectly

Describe TV prolapse

Systolic bowing of the belly of the leaflets into the RA during systole

How well did you know this?

Not at all

Perfectly

TVP usually occurs with what other pathology of the L heart

MVP

How well did you know this?

Not at all

Perfectly

Describe Ebsteins anomaly

4 main characteristics

A congenital malformation of the TV leaflets

Adhesion of the septal and post leaflets to the myocardium
Exaggerated apical displacement of the septal leaflet
Atrialization and dilation of a portion of the RV inflow tract
Small functional RV

How well did you know this?

Not at all

Perfectly

What does exaggerated apical displacement of the TV septal leaflet cause

Leaflets cant coapt which leads to TR

How well did you know this?

Not at all

Perfectly

Ebsteins anomaly is associated w/ which other abnormalities

PFO or ASD
Congenitally corrected transposition of great vessels
VSDs
hypoplastic pulmonary artery

How well did you know this?

Not at all

Perfectly

How can Ebsteins affect the development of conduction pathways

What can this lead to

May lead to maldevelopment of the conduction pathway from the atria to the ventricles…..

… Wolfe-Parkinson White syndrome

How well did you know this?

Not at all

Perfectly

What is Wolfe-Parkinson White syndrome

Early scoop of the QRS complex

How well did you know this?

Not at all

Perfectly

Criteria for diagnosing Ebsteins anomally

To which insertion point should you compare it

TV septal leaflet displaced apical >2 cm

MV in the A4CH view

How well did you know this?

Not at all

Perfectly

How can Ebsteins affect the movement and appearance of the anterior and septal TV leaflets

Anterior may have restricted motion

Septal may have whip-like motion and be longer w/ redundant tissue?

How well did you know this?

Not at all

Perfectly

what should you always assess for w/ spectral doppler if the patient has ebsteins

ASD or PFO w/ colour and PW

How well did you know this?

Not at all

Perfectly

if theres an IAS w/ ebsteins, how might the direction be different

what is this called

shunt direction may be from right to left instead of left to right due to increased right heart press from TR

Eisenemnger’s

How well did you know this?

Not at all

Perfectly

w/ ebsteins how will the bowing of the IVS change

will be to the LV…. the L heart will look squished

How well did you know this?

Not at all

Perfectly

common causes of annular dilation of the TV leading to functional TR

dilated cardiomyopathy
ASDs
pulmonary hypertension

ASD can cause pulmonary hypertension

How well did you know this?

Not at all

Perfectly

how do large ASDs affect the right heart

larger ASDs can have significant shunts of > 50% to the R heart which causes the R heart chambers to dilate

chronic, severe pulmonary hypertension (PHT) is associated w/ dilation of which structures

RV and TV annulus

what happens to the TV leaflets as the pap muscles in the RV migrate away from the TV annulus

tenting and lack of coaptation

does TR peak velocity reflect the severity of the TR?

what does TR peak velocity reflect

press difference b/w the RV and RA during systole

does severe TR usually have a high or low velocity jet

usually low, because of the larger opening of the TV which will lower the PG b/w the RV and RA

w/ RV volume overload, when will you see the "D" sign of the LV is short axis

only during systole

w/ RV pressure overload, when will you see the "D" sign of the LV is short axis common cause of press overload

throughout the entire cardiac cycle lung damage

does volume overload often lead to press overload

yes

severe/progressive TR will show what signs

``` signs of RHF: increased JVP hepatomegaly peripheral edema ascites ```

3 ways we indirectly estimate the severity of TR w/ colour doppler

1. colour jet are 2. vena contracta width 3. flow convergence radio (PISA)

4 ways we indirectly estimate the severity of TR w/ spectral doppler

1. TV inflow (PW) 2. hepatic vein profile (reversal during systole) 3. Intensity of TR signal 4. TR jet contour

2 quantitative parameters to assess severity of TR

1. regurgitant volume 2. effective regurg orifice area BOTH USING PISA TR

limitations of colour doppler for TR severity

- overestimation of TR jet: - jet displaces blood already sitting in the chamber.... trace only the aliased area - over gained - underestimation of TR jet: - occurs w/ eccentric jets which hug the atrial wall - severe lack of coaptation leads to huge hole in the TV and leads to only dark blue colour jet due to lower velocity (wont be aliased)

what is it called when an eccentric jet hugs the atrial wall

coanda effect

how do we determine the TR jet area

trace around the aliased part of the jet in systole, dont not trace any dark blue (represents the displaced blood)

value for mild TR jet area severe

Mild: < 5 cm^2 severe: >10 cm^2

value for mild TR vena contracta severe

mild: < 3mm (use MR value) severe: > 7 mm

can you use the vena contracta and PISA method when there are multiple jets

in which views can you measure vena contracta for TR

RVIT or 4CH should zoom

in which views can you measure PISA for TR how do you do it

A4CH zoom and lower colour scale to 28 cm/s

value for PISA for mild TR severe

mild: = 0.5 mm severe: >/= 9 mm

how will the TV inflow change w/ TR velocity over what value could indicate severe TR

velocity of the inflow will increase, as well as volume since the volume from the TR is also going through the valve > 1 m/s for the E wave: called E wave dominant

how will the HV flow profile change with TR

you will see reversal in later systole... w/ at least moderate TR, and the flow becomes diastolic dominant

is reversal in the HV sensitive or specific to severe TR

sensitive.... b/c there are other causes of HV systolic flow reversal

why does the liver get enlarged w/ TR

theres less forward flow in the the IVC, blood backs up into the liver

technical factors that limit the accuracy of TR CW brightness to determine severity

1. gain -over-gaining or under-gaining... use inflow as control 2. doppler angle, get as aligned as possible

shape of mild TR w/ CW why

parabolic b/c the press gradient b/w the RV and RA is maintained throughout all of systole

shape of severe TR w/ CW why

triangular with an early peak the press gradient drops off rapidly throughout systole due to a quick rise in pressure in the RA from the regurg volume.

name for the triangular appearance of severe TR

V cut off

TR peak velocity w/ massive TR

< 2 m/s

formula for EROA

EROA = (2 x pie x r^2 x Vn) / V of TR

what does the 2 x pie x r^2 represent in the EROA

surface areA of the hemispheric shell derived from flow convergence radius prox to the TV

what does the Vn represent in the EROA

colour nyquist limit (what the colour scale is set to below the baseline)

formula for the regurg volume using the EROA

RV = EROA x VTI of TR

value for Regurg volume for mild TR severe

mild: < 30 ml severe: >/= 45

value for EROA for mild TR severe

mild: = 0.20 cm^2 severe: >/= 0.40 cm^2

2 general causes of PR

functional/secondary: causes that lead to annular dilation, and then poor coaptation of the cusps.... PR valve anatomy is normal organic/primary: PR due to abnormalities of the cusps

clinical manifestation of PR

symptoms are due to RV volume overload: ``` dyspnea peripheral edema fatigue increased JVP liver engorgement ```

etiology of functional PR

``` RV cardiomyopathy RV infarction PHT Pulmonary artery dilation congenital heart disease ```

etiology of organic PR

``` carcinoid congenital lesions iatrogenic rheumatic valve disease trauma ```

in which view do you want to measure jet width for PR

PSAX RVOT due to lateral resolution

when do you start to see flow reversal in the main PA w/ PR what would be a strong indicator of severe PR

moderate PR seeing PR in the R or L pulmonary artery branches... the more distal, the more severe

what is the jet width ratio for PR formula

ratio of the width of the PR jet to the RVOT diameter PR jet width/RVOTd

what does a jet width of 0.7 mean

the width of the jet is >/= 70% of the RVOT diameter

jet width for severe PR

>0.7

how does steepness of the PR slow correlate w/ severity

steeper the slope = more severe... short decel time that ends before the end of diastole may be severe

value for moderate press 1/2 time severe

mod: > 100 ms severe: < 100 ms

why does the PR velocity slow?

PA press falls due to regurg back into the RV and inflow into the RV, which equalizes the press b/w the chambers

what is the pulmonary regurg index (PRI)

a measure of the ratio of the duration of the PR signal to the total duration of diastole.. the earlier the PR signal ends, the more severe the PR, b/c press is equalizing fast

values for mild PRI severe

mild: 1 severe: < 0.77

when would pre-systolic flow occur w/ PR and why does it happen

w/ severe PR or other conditions like RV diastolic dysfunction (RV very stiff) when the RVEDP exceeds the PA press, forward flow occurs

when there is severe PR and we see forward diastolic floe, what do we assume is the cause

severe PR

when there is PR present, which pressure should we be calculating instead of RVSP

PAEDP and mPAP

formula for PAEDP and mPAP

PAEDP: 4 (v^2) + RAP mPAP: 4 (v^2) + RAP

where are PAEDP and mPAP located

mPAP is at the peak diastolic velocity of the PR PAEDP is at the lowest diastolic velocity of PR

C11: TV And PV Regurg Flashcards

(80 cards)