Valvular insufficiency

Question 1

Evaluation of valvular regurgitation involves assessment of what five things?

Answer 1

1. the valve anatomy
2. severity of regurgitation
3. chamber enlargement due to the volume overload
4. ventricular function
5. degree of pulmonary hypertension

Question 2

What are the two categories of valvular regurgitation etiology?

Answer 2

congenital

acquired abnormalities of the leaflets or supporting structures

Question 3

What is the EROA?

Answer 3

Effective Regurgitant Orifice Area

the size of the hole creating the leak

Question 4

The velocity of the jet is related to what?

Answer 4

The pressure across the valve

NOT the severity of the regurgitation

Question 5

The area of the jet is indicative of what?

Answer 5

severity of regurgitation

keeping in mind its size and shape can be effected by physiologic and technical factors

Question 6

How is the pressure gradient calculated?

Answer 6

The Bernoulli equation

Question 7

What is the PISA?

Answer 7

Proximal isovelocity surface area

the hemisphere of aliased color (proximal to the direction of the regurgitant jet)

Question 8

Increased antegrade velocity may be seen if what?

Answer 8

the regurgitation is severe

Question 9

What is the Vena Contracta and what does it represent?

Answer 9

the narrowest segment of the regurgitant jet adjacent to the regurgitant orifice
the size of the neck is representative of the size of the hole or regurgitant orifice

Question 10

Chronic valvular regurgitation results in what?

Answer 10

Progressive volume overload

Question 11

Volume overload of the LV leads to what?

Answer 11

dilation with normal wall thickness and therefore increased mass
(EKG may show LVH, interventricular conduction delays, or repolarization abnormalities)
chronic LV overload can irreversible effect systolic function

Question 12

What is the treatment of chronic LV overload (in the absence of symptoms)?

Answer 12

serial echos are used to evaluate changes in size and function and to time replacement or repair

Question 13

What is physiologic regurgitation?

Answer 13

small degree of regurgitation present in a high percentage of otherwise normal individuals

• spatially restricted to the area immediately adjacent to the valve closure
• short in duration
• represents only a small regurgitant volume
• weakly stained

Question 14

Incidence of physiologic regurgitation (MR, TR, PI, AI)?

Answer 14

MR 70-80%
TR 80-90%
PI 70-80%
AI 5%

Question 15

What are the five semi quantitative measures used to evaluate the severity of regurgitation?

Answer 15

1. color jet area
2. vena contracta width
3. PISA
4. doppler shape and intensity (PHT for AI)
5. flow reversal

Question 16

What are the three quantitative measures used to evaluate the severity of regurgitation?

Answer 16

1. regurgitant volume
2. regurgitant fraction: regurgitant volume/ stroke volume
3. effective regurgitant orifice area