Part III Cardiac Abnormalities




9 Valvular Heart Disease



9. 1 Aortic Stenosis



9. 1.1 Aortic Stenosis, General


No Image Available!




Fig. 9.1 Top: Calcified semilunar cusps in aortic stenosis. Bottom: Pressure overload causes concentric left ventricular hypertrophy.



No Image Available!




Fig. 9.2 The parasternal short-axis view is particularly well-suited for visualizing decreased opening motion although separation does not permit estimation of the degree of stenosis.



M-Mode Echocardiography


No Image Available!




Fig. 9.3 M-mode recording across the aortic valve shows echodense, bandlike reflections of the calcified valve apparatus with reduced opening motion. Separation cannot be thoroughly displayed and provides no indication of degree of stenosis.



Doppler Echocardiography


No Image Available!




Fig. 9.4 The accelerated outflow across the aortic valve is represented in the continuous-wave (CW) Doppler mode by a V-shaped flow profile with increased velocities. The recorded velocities (preferably including stroke volume) are used for quantification purposes.



Color Doppler Imaging


No Image Available!




Fig. 9.5 The stenotic aortic valve causes an increase in flow velocity with corresponding color change above the valve.



No Image Available!




Fig. 9.6 Increased outflow across the aortic valve can be readily demonstrated in the apical five-chamber view.



9. 1.2 Medium-Grade Aortic Stenosis


No Image Available!




Fig. 9.7 Moderately calcified valves in medium-grade aortic stenosis. The moderately elevated pressure gradient has not caused hypertrophy of the left ventricle.



No Image Available!




Fig. 9.8 CW Doppler mode displays a moderate rise in flow velocity up to approximately 3 m/s. Computer-assisted conversion yields a maximum gradient of 36 mmHg.



9. 1.3 High-Grade Aortic Stenosis


No Image Available!




Fig. 9.9 Marked calcification of the aortic valve. There is concentric left ventricular hypertrophy.



No Image Available!




Fig. 9.10 CW Doppler demonstrating a rise in flow velocity up to 5 m/s, corresponding to a maximum gradient of 100 mmHg. Patience and time are necessary to obtain a usable CW analysis of transaortic flow.



9. 2 Mitral Stenosis



9. 2.1 Mitral Stenosis, General


No Image Available!




Fig. 9.11 Top: Calcified mitral valve in mitral stenosis. Bottom: Dilatation of the left atrium and right heart as a result of pressure overload.



No Image Available!




Fig. 9.12 In the parasternal short-axis view, the remaining mitral valve orifice area can be seen directly and planimetered using computer analysis. Under good visualization, this value can be used for quantification.



M-Mode Echocardiography


No Image Available!




Fig. 9.13 M-mode across the mitral valve shows decreased opening motion of both leaflets. Limited opening motion is not a valid parameter for estimating degree of severity.



Doppler Echocardiography


No Image Available!




Fig. 9.14 Top: CW Doppler recording showing increased transmitral velocity as well as a flat decline in transmitral inflow. Bottom: Computer-assisted measurement of diastolic pressure gradient is used for quantification (so-called pressure half-time).



9. 2.2 Low-Grade Mitral Stenosis


No Image Available!




Fig. 9.15 Top: Moderate calcification of the valve leaflets and atrial dilatation. Bottom: The minimal increase in transmitral inflow velocity causes a circumscribed color change.



No Image Available!




Fig. 9.16 Top: CW Doppler shows a rapid decline in transmitral inflow. Bottom: Computer-assisted quantification yields a functional valve orifice area of > 2 cm2.



9. 2.3 High-Grade Mitral Stenosis


No Image Available!




Fig. 9.17 Marked calcification of the mitral valves as well as a considerably dilated left atrium can be seen. Increased inflow velocity across the stenotic valve appears like a candle flame in the image.



No Image Available!

Nov 10, 2021 | Posted by in CARDIOLOGY | Comments Off on Part III Cardiac Abnormalities
Premium Wordpress Themes by UFO Themes