Aortic Stenosis: LVOT Obstruction
|
|
- Maude Welch
- 6 years ago
- Views:
Transcription
1 Aortic Stenosis: LVOT Obstruction Raymond Stainback, MD 7 th annual Houston Echo Review 2016: Boot Camp for the Echo Board
2 Murmur: Additional heart or vascular sound due to normal or abnormal turbulent blood flow heard during auscultation Innocent murmur: most innocent murmurs are soft (less than or equal to grade 2/6), heard in early systole, characterized as crescendo-decrescendo type, and may vary with position consistent with normal blood flow including but not limited to: Still s murmur pulmonary flow murmur physiologic peripheral pulmonary stenosis (peds) supraclavicular arterial bruit venous hum Pathologic murmur: suggestive of a cardiovascular abnormality (not clearly innocent including but not limited to: diastolic holosystolic late systolic > grade 3/6 systolic continuous (other than venous hums) harsh provoked or become louder with changes in position (e.g., squatting to standing) or strain phase of Valsalva maneuver
3 Normal Aortic Valve TTE Anterior TEE IAS Posterior LA TV RA RVOT R N L PV RA TV N L R RVOT PV IAS LA Posterior Anterior TEE TTE TEE
4 Aortic Stenosis Valvular Subvalvular Supravalvular
5 Aortic Stenosis Valvular Subvalvular Supravalvular
6 Valvular Aortic Stenosis Recognition by 2D exam Morphological Clues to Etiology Doppler Severity Assessment Gradient Valve Area Technical Considerations
7 Common Valvular AS Acquired Congenital Rheumatic
8 Congenital AS Bicommissural Notice patient s age < 15 yrs 60% unicuspid yrs60% bicuspid >65 yrs 90% tricuspid Weyman Principals & practice of echo pg 511 Acquired, not congenital
9 M-mode, Aortic Valve
10 Calcific AS
11 Bicuspid Aortic Valve
12 Bicuspid Aortic Valve 1-2 % of pop. males 4:1 (isolated defect) assoc. PDA, Coarct.Ao (20%) AS, AI, AoRoot aneurysm, SBE
13
14 Rheumatic Aortic Stenosis
15 Rheumatic Aortic Valve
16 AS Severity Spectral Doppler analysis CW Doppler Peak Velocity Timing of Peak Velocity (shape of envelope) Peak Gradient Mean Gradient Pulsed Doppler Dimensionless Index Valve Area by Continuity Equation Valve Area by Planimetry (2D)
17 Weyman Principals & practice of echo pg 521
18 Severity By Doppler Alone Mean Grad > 50 mmhg Severe Mean Grad mmhg Uncertain Use Continuity Equation! Peak Grad. < mm Hg (normal LV) mild Peak Vel. > 4 m/sec likely Severe
19 Weyman Principals & practice of echo pg 516 Early Peak Mid peak 2.4 m/s 4.0 m/s 5.0 m/s 5.8 m/s Nl - mild Mod Severe
20 Prospective study of asymptomatic AS: clinical echo & exercise predictors of outcome. Otto, et al Circ 1997:95
21 Aortic Gradient Peak Gradient varies dramatically with: HR Blood Pressure Stroke volume Inotropic state Therefore, Aortic Valve Area calculation is the most reliable echocardiographic indicator of Severity
22 AS Severity 2006 Area, cm2 Mean grad. mm Hg Peak Vel. m/s Mild 1.5 <25 3 Mod Severe <1.0 >40 > 4 ACC/AHA Practice Guidelines JACC, Aug 1, 2006
23
24 2014 AHA / ACC Guideline for Valvular Heart disease
25 Weyman Principals & practice of echo pg 525
26 Continuity Equation AVA = CSA LVOT x (VTI LVOT / VTI AoV ) п 3.14 circle = п r 2 AVA = п(d/2) 2 x (VTI LVOT / VTI AoV ) OR AVA = (D 2 x 0.785) x (VTI LVOT / VTI AoV ) OR Either V or VTI is valid AVA = (D 2 x 0.785) x (V LVOT / V AoV )
27 LVOT diameter Diameter 2 ~Error 2
28
29 AoV Continuous Doppler, Apical
30 Pulsed Doppler: Good Sample Volume Placement Near valve, but still laminar Weyman Principals & practice of echo pg 501
31 Steerable CW, Imaging transducer Blind CW, Pedoff transducer
32 Potential Pitfall: not coaxial to flow Also: Use nonimaging CW probe The Echo Manual, 1 st Edition
33 Pitfall of Continuous Doppler: AoV Systolic velocities besides AS. which is which? MV Weyman Principals & practice of echo pg 522
34 AoV Peak Gradient? 81mm Hg 37mm Hg
35 Rhythm: Sequential regular beats! AoV Peak Gradient? 81mm Hg 37mm Hg 70mm Hg? Post PVC? PVC Regular Sinus Rhythm Irregular rhythm (Afib): Acquire 5-10 representative cycles.
36 Dimensionless Obstructive Index Vmax LVOT / Vmax AoV = DOI DOI <.25 Weyman Principals & practice of echo pg 505 suggests severe obstruction Useful: As a check High gradients in setting of high flow Unable to use continuity equation
37 Equivocal Severe AS Dobutamine stress Echo Severe AS (AoVA < 1 cm2 by Continuity Equation) Low valve gradient defilippi et al. Am J Cardiol 1995;75:191-4
38 Case: 74 yr. male Equivocal AS Baseline Dobutamine 20 ug/kg/min SV = 67 ml SV = 78 ml LVOT = 2.2 cm 2 Diagnosis: primary CM Treatment: medical mgt of HF Peak = 36 mm Hg AoV Area =.8 cm 2 Severe AS Peak = 64 mm Hg AoV Area = 1.2 cm 2 Mod AS
39 Question AoV area by continuity =.8 cm2 LVEF = 30% AoV peak gradient = 80 mm Hg Is Dobutamine stress echo needed? Yes / No
40 Question AoV area by continuity =.8 cm2 LVEF = 30% (SV = 65 ml) AoV peak gradient = 80 mm Hg Is Dobutamine stress echo needed? Despite Low LVEF, SV is normal and Peak gradient is appropriately high. Degree of AS is not equivocal. Gradient not low.
41 AoV area by continuity =.8 cm2 LVEF = 30% (stroke volume 30 ml) AoV peak gradient = 45 mm Hg Is Dobutamine stress echo needed? Yes / No
42 AoV area by continuity =.8 cm2 LVEF = 30% (stroke volume 30 ml) AoV peak gradient = 45 mm Hg Is Dobutamine stress echo needed? Yes
43 AS Severity in Doubt Everything heretofore depends upon excellent imaging What if: Discrepant Cath Data Surface echo poor Distorted LVOT One or more variables poor Valve morphology doesn t match Doppler data Irregular rhythm
44 TEE Planimetry in Calcific AS
45 AoV Planimetry by TEE Area =.9 cm 2
46 Do Not do TEE Planimetry Too calcified (edges not clear) Too High Gain settings bicuspid or congenital AS (funnel)
47 AoV area by continuity =.8 cm2 LVEF = 30% (stroke volume 30 ml) AoV peak gradient = 45 mm Hg Would TEE for AoV area (planimetry) be helpful? Yes / No
48 AoV area by continuity =.8 cm2 LVEF = 30% (stroke volume 30 ml) AoV peak gradient = 45 mm Hg Would TEE for AoV area (planimetry) be helpful? No
49 Aortic Stenosis Valvular Subvalvular Supravalvular
50
51 LV Outflow Obstruction Valvular Subvalvular Dynamic Fixed Supravalvular
52 Dynamic LVOT obstruction (HOCM / SAM)
53 Dynamic LVOT obstruction (HOCM / SAM)
54 SAM dynamic LVOT obstuction LVOT CW Late-peaking (50 mm Hg) High Velocity MR Jet (V = 7 m/s)
55
56 Systolic Notching AoV Systolic Anterior Motion (SAM)
57 LV Outflow Obstruction (differential diagnosis) Valvular Subvalvular Dynamic Fixed Supravalvular
58 Discrete Subaortic Stenosis 10% of congenital AS Membrane, Ridge, Tunnel Shone s synd. (with Ao coarct. & congen. MS)
59 Tunnel Subaortic Stenosis
60 Subaortic Stenosis: Color Flow convergence in LVOT (well below AV)
61 Apical CW Doppler 40 mm Hg Suprasternal Notch 70 mm Hg Sub-AS AR!
62 Supravalvular Aortic Stenosis Nonfamilial, sporadic (nl IQ, nl facies) Familial (auto. Dom, nl IQ, nl facies) Williams syndrome ( elfin facies, mental retardation, branch PS, elastin gene, chrom 7q22.23) 1: 20,000 births 3 Types: Hourglass Membrane Hypoplastic
63 Associated findings Supravalvular AS Supravalvular PS (often Distal) Backer. CTS.net R.Shah. Amer.J. Roent. 2000
64 Case X, apical views
65 Case X, TEE Nonfamilial, sporadic (nl IQ, nl facies)
66 Case X, TTE apical views Peak gradient = 79 mm Hg; V = 4.5 m/s
67 Pressure Recovery Weyman Principals & practice of echo Understand this concept
68 LV Outflow Obstruction (differential diagnosis) Valvular Subvalvular Dynamic Fixed Supravalvular
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal
More informationCongenital. Unicuspid Bicuspid Quadricuspid
David Letterman s Top 10 Aortic Stenosis The victim can be anyone: Echo is the question and the answer!!!! Hilton Head Island Echocardiography Conference 2012 Timothy E. Paterick, MD, JD, MBA Christopher
More informationHow to Assess and Treat Obstructive Lesions
How to Assess and Treat Obstructive Lesions Erwin Oechslin, MD, FESC, FRCPC, Director, Congenital Cardiac Centre for Adults Peter Munk Cardiac Centre University Health Network/Toronto General Hospital
More informationComprehensive Echo Assessment of Aortic Stenosis
Comprehensive Echo Assessment of Aortic Stenosis Smonporn Boonyaratavej, MD, MSc King Chulalongkorn Memorial Hospital Bangkok, Thailand Management of Valvular AS Medical and interventional approaches to
More informationBack to Basics: Common Errors In Quantitation In Everyday Practice
Back to Basics: Common Errors In Quantitation In Everyday Practice Deborah Agler, ACS, RDCS, FASE October 9, 2017 ASE: Echo Florida Rebecca T. Hahn, MD Director of Interventional Echocardiography Professor
More informationG. AORTIC STENOSIS (AS)
G. AORTIC STENOSIS (AS) DEFINITION THE FACTS Aortic stenosis (AS) is a narrowing/thickening/obstruction of the aortic valve (AOV) that impedes systolic flow traveling from the left ventricle, through the
More informationLeft Ventricular Outflow Tract Obstruction
Left Ventricular Outflow Tract Obstruction Department of Paediatrics Left Ventricular Outflow Tract Obstruction Subvalvular aortic stenosis Aortic Stenosis Supravalvular aortic stenosis Aortic Coarctation
More informationDobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies
Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR William A. Zoghbi MD, FASE, MACC Professor and
More informationMAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS
MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine Director, Structural Heart Imaging The Ohio State University
More informationP = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation
Comprehensive Hemodynamic Evaluation by Doppler Echocardiography Itzhak Kronzon, MD North Shore LIJ/ Lenox Hill Hospital New York, NY Disclosure: Philips Healthcare St. Jude Medical The Simplified Bernoulli
More informationStage of Valvular AS. Outline 10/14/16. Low-flow and Other Challenges to the Assessment of Aortic Stenosis. Severe AS
Low-flow and Other Challenges to the Assessment of Aortic Stenosis Nithima Ratanasit, MD, FACC, FASE Siriraj Hospital, Mahidol University Bangkok, Thailand Outline Types of low-flow aortic stenosis Assessment
More informationEarly Surgery in Asymptomatic Severe Aortic Stenosis Pros and Cons
Early Surgery in Asymptomatic Severe Aortic Stenosis Pros and Cons Duk-Hyun Kang, M.D. Division of Cardiology Asan Medical Center Seoul, Korea Background Dilemma of balancing the risks versus benefits
More informationMurmur Sounds made by turbulence in the heart or blood stream. 1. Timing. 5. Intensity 2. Shape. 6. Pitch 3. Location of maximum intensity
Definition Items in description of Timing Shape Location of maximum intensity Murmur Sounds made by turbulence in the heart or blood stream. 1. Timing 5. Intensity 2. Shape 6. Pitch 3. Location of maximum
More informationHemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics
Hemodynamic Assessment Matt M. Umland, RDCS, FASE Aurora Medical Group Milwaukee, WI Assessment of Systolic Function Doppler Hemodynamics Stroke Volume Cardiac Output Cardiac Index Tei Index/Index of myocardial
More informationDOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES
THORAXCENTRE DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES J. Roelandt DOPPLER HEMODYNAMICS Intracardiac pressures and pressure gradients Volumetric measurement
More informationAppendix II: ECHOCARDIOGRAPHY ANALYSIS
Appendix II: ECHOCARDIOGRAPHY ANALYSIS Two-Dimensional (2D) imaging was performed using the Vivid 7 Advantage cardiovascular ultrasound system (GE Medical Systems, Milwaukee) with a frame rate of 400 frames
More informationEchocardiographic evaluation of mitral stenosis
Echocardiographic evaluation of mitral stenosis Euroecho 2011 Philippe Unger, MD, FESC Erasme Hospital, ULB, Brussels, Belgium I have nothing to declare EuroHeart Survey Etiology of single native left-sided
More informationEcho Doppler Assessment of Right and Left Ventricular Hemodynamics.
Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP Northwell, Lenox Hill Hospital, New York Professor of Cardiology Hofstra University
More informationThe Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington
The Doppler Examination Katie Twomley, MD Wake Forest Baptist Health - Lexington OUTLINE Principles/Physics Use in valvular assessment Aortic stenosis (continuity equation) Aortic regurgitation (pressure
More informationUsually we DON T need to go beyond the gradient
Aortic Stenosis Going Beyond the Gradient James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School of Medicine, Northwestern
More informationNormal TTE/TEE Examinations
Normal TTE/TEE Examinations Geoffrey A. Rose, MD FACC FASE Sanger Heart & Vascular Institute Before you begin imaging... Obtain the patient s Height Weight BP PLAX View PLAX View Is apex @ 9-10 o clock?
More informationStress Testing in Valvular Disease
2017 ASE Florida Orlando, FL October 10, 2017 2:40 2:50 PM 10 min Grand Harbor Ballroom South Stress Testing in Valvular Disease Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate
More informationProsthesis-Patient Mismatch or Prosthetic Valve Stenosis?
EuroValves 2015, Nice Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE FESC Canada Research Chair in Valvular Heart Diseases Université LAVAL Disclosure
More informationEcho Assessment Pre-TAVI
Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial Interest /arrangement or affiliation with the organization(s) listed below Echocardiographic
More informationComprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter.
Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP North Shore HS, LIJ/Lenox Hill Hospital, New York
More informationAortic stenosis aetiology: morphology of calcific AS,
How to improve patient selection in aortic stenosis? Fausto J. Pinto, FESC Aortic stenosis aetiology: morphology of calcific AS, bicuspid valve, and rheumatic AS (Adapted from C. Otto, Principles of
More informationWorkshop Facing the challenge of TAVI 2016
Workshop Facing the challenge of TAVI 2016 Congrès annuel de la SSC Lausanne 15 Juin 2016 Pitfalls in the severity assessment of aortic stenosis by echocardiography Hajo Müller, unité d échocardiographie,
More informationDoppler Basic & Hemodynamic Calculations
Doppler Basic & Hemodynamic Calculations August 19, 2017 Smonporn Boonyaratavej MD Division of Cardiology, Department of Medicine Chulalongkorn University Cardiac Center, King Chulalongkorn Memorial Hospital
More informationECHO HAWAII. Role of Stress Echo in Valvular Heart Disease. Not only ischemia! Cardiomyopathy. Prosthetic Valve. Diastolic Dysfunction
Role of Stress Echo in Valvular Heart Disease ECHO HAWAII January 15 19, 2018 Kenya Kusunose, MD, PhD, FASE Tokushima University Hospital Japan Not only ischemia! Cardiomyopathy Prosthetic Valve Diastolic
More informationADULT CONGENITAL HEART DISEASE. Stuart Lilley
ADULT CONGENITAL HEART DISEASE Stuart Lilley More adults than children have congenital heart disease Huge variety of congenital lesions from minor to major Heart failure, re-operation and arrhythmia are
More informationPhysical Exam Part II
Physical Exam Part II University of Michigan Cardiovascular Center Kim A. Eagle, MD Albion Walter Hewlett Professor Director Physical Exam: Part II Heart Sounds Heart Murmurs HEART SOUNDS S1 MITRAL + TRICUSPID
More informationHISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?
HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered
More informationHEMODYNAMIC ASSESSMENT
HEMODYNAMIC ASSESSMENT INTRODUCTION Conventionally hemodynamics were obtained by cardiac catheterization. It is possible to determine the same by echocardiography. Methods M-mode & 2D echo alone can provide
More informationRVOTO adult and post-op
Right ventricular outflow tract obstruction in the adult: native and post-op Helmut Baumgartner Westfälische Wilhelms-Universität Münster Adult Congenital and Valvular Heart Disease Center University of
More informationBritish Society of Echocardiography
British Society of Echocardiography Affiliated to the British Cardiac Society A Minimum Dataset for a Standard Adult Transthoracic Echocardiogram From the British Society of Echocardiography Education
More informationAffecting the elderly Requiring new approaches. Echocardiographic Evaluation of Hemodynamic Severity. Increasing prevalence Mostly degenerative
Echocardiographic Evaluation of Hemodynamic Severity Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona Relevant Financial Relationship(s) None Off Label Usage None A re-emerging public-health
More informationAortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology
Aortic Stenosis: UPDATE 2010 Anjan Sinha, MD Krannert Institute of Cardiology None Disclosures 67-Year-Old Male Dyspnea and angina Class III heart failure No PND or orthopnea 3/6 late peak SEM Diminished
More informationCardiac Ausculation in the Elderly
Cardiac Ausculation in the Elderly 박성하 신촌세브란스병원심장혈관병원심장내과 Anatomy Surface projection of the Heart and Great Vessels Evaluating pulsation Superior vena cava Rt. pulmonary artery Right atrium Right ventricle
More informationCases in Adult Congenital Heart Disease
Cases in Adult Congenital Heart Disease Sabrina Phillips, MD FACC FASE Associate Professor of Medicine The University of Oklahoma Health Sciences Center No Disclosures I Have Palpitations 18 Year old Man
More informationRelevant Financial Relationship(s) Off Label Usage. None. None
Different Variants Amr E Abbas, MD, FACC, FSCAI, FASE, FSVM Director, Interventional Cardiology Research Beaumont Health Associate Professor of Medicine, OU/WB School of Medicine ASCeXAM/ReASCeXAM 2018
More informationWhat are the best diagnostic tools to quantify aortic regurgitation?
What are the best diagnostic tools to quantify aortic regurgitation? Agnès Pasquet, MD, PhD Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université catholique de Louvain
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationQuantitation of Aortic Regurgitation ASCeXAM / ReASCE Review Course
Quantitation of Aortic Regurgitation 2017 ASCeXAM / ReASCE Review Course David Adams, ACS, RCS, RDCS, FASE Duke University Medical Center May 1, 2017 Disclosures None 1 Exam based on: Zoghbi et al. JASE
More informationQuantification of Aortic Regurgitation
Quantification of Aortic Regurgitation ASE Review 2018 Boston Susan E Wiegers, MD, FASE, FACC Professor of Medicine And thanks to Dr. Roberto Lang Disclosure None related to this presentation 1 Objectives
More informationHISTORY. Question: What category of heart disease is suggested by this history? CHIEF COMPLAINT: Heart murmur present since early infancy.
HISTORY 18-year-old man. CHIEF COMPLAINT: Heart murmur present since early infancy. PRESENT ILLNESS: Although normal at birth, a heart murmur was heard at the six week check-up and has persisted since
More informationECHOCARDIOGRAPHY DATA REPORT FORM
Patient ID Patient Study ID AVM - - Date of form completion / / 20 Initials of person completing the form mm dd yyyy Study period Preoperative Postoperative Operative 6-month f/u 1-year f/u 2-year f/u
More informationTAVR TTE INTERROGATION BY ALAN MATTHEWS
TAVR TTE INTERROGATION BY ALAN MATTHEWS KEYS TO ACCURATE ASSESSMENT EDWARDS SAPIEN VALVE 3 PHASES OF TAVR TTE Evaluation (Qualifying) Placement (Intraoperative) Follow-up (Post-Op) GOALS High quality TTE
More informationSwan Song: Echocardiography as a Pulmonary Artery Catheter? Interdepartmental Division of Critical Care Medicine
Swan Song: Echocardiography as a Pulmonary Artery Catheter? The swan is without spot, and it sings sweetly as it dies, that song ending its life Leonardo Da Vinci Curr Opin Anesthesiol 2016, 29:36 45 Circulation.
More informationEchocardiographic assessment in Adult Patients with Congenital Heart Diseases
Echocardiographic assessment in Adult Patients with Congenital Heart Diseases Athanasios Koutsakis Cardiologist, Cl. Research Fellow George Giannakoulas Ass. Professor in Cardiology 1st Cardiology Department,
More informationGiovanni Di Salvo MD, PhD, FESC Second University of Naples Monaldi Hospital
Giovanni Di Salvo MD, PhD, FESC Second University of Naples Monaldi Hospital VSD is one of the most common congenital cardiac abnormalities in the newborn. It can occur as an isolated finding or in combination
More informationManagement of HOCM: Non-Surgical Options
Management of HOCM: Non-Surgical Options Howard C. Herrmann, MD, FACC, MSCAI John Bryfogle Professor of Cardiovascular Medicine and Surgery Health System Director for Interventional Cardiology Director,
More informationTAVR: Echo Measurements Pre, Post And Intra Procedure
2017 ASE Florida, Orlando, FL October 10, 2017 8:00 8:25 AM 25 min TAVR: Echo Measurements Pre, Post And Intra Procedure Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate
More informationThe production of murmurs is due to 3 main factors:
Heart murmurs The production of murmurs is due to 3 main factors: high blood flow rate through normal or abnormal orifices forward flow through a narrowed or irregular orifice into a dilated vessel or
More informationMitral Valve Stenosis: What do I need to know? ACC Latin American Conference 2017
Mitral Valve Stenosis: What do I need to know? ACC Latin American Conference 2017 Athena Poppas, MD FACC FASE Past ACC Scientific Sessions Chair, ACC Board of Trustee Professor of Medicine, Brown University
More informationNothing to Disclose. Questions. Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Paul Wood at the Nathanson Lecture, 1958
Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Nothing to Disclose Gabriel Gregoratos, MD, FACC, FAHA Questions Can one improve globally on the asymptomatic state? and if
More informationBogdan A. Popescu. University of Medicine and Pharmacy Bucharest, Romania. EAE Course, Bucharest, April 2010
Bogdan A. Popescu University of Medicine and Pharmacy Bucharest, Romania EAE Course, Bucharest, April 2010 This is how it started Mitral stenosis at a glance 2D echo narrow diastolic opening of MV leaflets
More informationASE Guidelines on Aortic Regurgitation What Do I Measure? Case Studies
ASE Guidelines on Aortic Regurgitation What Do I Measure? Case Studies Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR William A. Zoghbi MD, FASE, MACC Professor and Chairman, Department
More informationM-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec
M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE Honoraria: Philips Classical M-mode Echocardiography M-Mode offers better time and image resolution. Sampling Rate M-Mode: 1800 / sec
More information2/4/2011. Nathan Kerner, M.D.
Nathan Kerner, M.D. Definition Elevated pressures - cut off usually >40 mmhg pulmonary artery systolic pressure (PASP) Usually associated with elevated pulmonary vascular resistance (PVR) measured in dynessec/cm
More informationProsthetic valve dysfunction: stenosis or regurgitation
Prosthetic valve dysfunction: stenosis or regurgitation Jean G. Dumesnil MD, FRCP(C), FACC, FASE(Hon) Quebec Heart and Lung Institute, Québec, Québec No disclosures Possible Causes of High Gradients in
More informationASCeXAM / ReASCE. Practice Board Exam Questions. Tuesday Morning
ASCeXAM / ReASCE Practice Board Exam Questions Tuesday Morning Congenital Heart Disease in Adults Congenital Heart Disease Cases Diastolic Function Pericardial Disease Congenital Heart Disease Cases Michael
More informationTricuspid and Pulmonary Valve Disease
Tricuspid and Pulmonary Valve Disease Lawrence Rudski MD FRCPC FACC FASE Professor of Medicine Director, Division of Cardiology Jewish General Hospital McGill University Question 1 All of the following
More informationICE: Echo Core Lab-CRF
APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction
More informationImaging Guide Echocardiography
Imaging Guide Guide to Small Animal Echocardiography using the Vevo Imaging Systems System Compatibility: This guide contains instructions and suggestions for work on the Vevo2100, VevoLAZR, Vevo 3100
More informationQuantification of Mitral Stenosis: Planimetry, pressure Half time, Continuity Common Errors
Quantification of Mitral Stenosis: Planimetry, pressure Half time, Continuity Common Errors Christopher J Kramer RDCS Advanced Cardiovascular Services Aurora Health Care Milwaukee, WI No Disclosures Baumgartner,
More informationTGA atrial vs arterial switch what do we need to look for and how to react
TGA atrial vs arterial switch what do we need to look for and how to react Folkert Meijboom, MD, PhD, FES Dept ardiology University Medical entre Utrecht The Netherlands TGA + atrial switch: Follow-up
More informationCase # 1. Page: 8. DUKE: Adams
Case # 1 Page: 8 1. The cardiac output in this patient is reduced because of: O a) tamponade physiology O b) restrictive physiology O c) coronary artery disease O d) left bundle branch block Page: 8 1.
More informationTransposition of the great arteries
EuroEcho 2010 - Teaching course on CHD Transposition of the great arteries - Follow-up after the arterial switch Gertjan Tj. Sieswerda, MD PhD Nothing to disclose Interuniversitary Institute for Congenital
More informationCMR for Congenital Heart Disease
CMR for Congenital Heart Disease * Second-line tool after TTE * Strengths of CMR : tissue characterisation, comprehensive access and coverage, relatively accurate measurements of biventricular function/
More informationMITRAL REGURGITATION ECHO PARAMETERS TOOL
Comprehensive assessment of qualitative and quantitative parameters, along with the use of standardized nomenclature when reporting echocardiographic findings, helps to better define a patient s MR and
More informationRole of Stress Echo in Valvular Heart Disease. Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan
Role of Stress Echo in Valvular Heart Disease Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan Exercise echocardiography Dobutamine echocardiography Usefulness of exercise echo
More informationAnaesthesia for non-cardiac surgery in patients left ventricular outflow tract obstruction (LVOTO)
Anaesthesia for non-cardiac surgery in patients left ventricular outflow tract obstruction (LVOTO) Dr. Siân Jaggar Consultant Anaesthetist Royal Brompton Hospital London UK Congenital Cardiac Services
More informationValvular Heart Disease. Dr. HANAN ALBACKR
Valvular Heart Disease Dr. HANAN ALBACKR Valvular Heart Disease Format for this lecture IMPORTANT CLINICAL INFO know for boards, tests and clinical practice Spectrum of VHD Aortic Valve Mitral Valve Tricuspid
More informationValvular Heart Disease
Valvular Heart Disease B K Singh, MD, FACC Disclosures: None 1 CARDIAC CYCLE S2 S2=A2P2 S1=M1T1 S4 S1 S3 2 JVP Carotid S1 Slitting of S2 S3 S4 Ejection click Opening snap Dynamic Auscultation What is the
More informationEchocardiographic Assessment of Valvular Heart Disease
2 1 Echocardiographic ssessment of Valvular Heart Disease Raymond F. Stainback Overview....................................... 488 Grading System for Valve Lesions.................. 488 Jet Lesion natomy
More information2019 Qualified Clinical Data Registry (QCDR) Performance Measures
2019 Qualified Clinical Data Registry (QCDR) Performance Measures Description: This document contains the 18 performance measures approved by CMS for inclusion in the 2019 Qualified Clinical Data Registry
More informationThe production of murmurs is due to 3 main factors:
Heart murmurs The production of murmurs is due to 3 main factors: high blood flow rate through normal or abnormal orifices forward flow through a narrowed or irregular orifice into a dilated vessel or
More informationEcho in Pulmonary HTN
Echo in Pulmonary HTN Steven A. Goldstein MD FACC FASE Professor of Medicine Georgetown University Medical Center MedStar Heart Institute Washington Hospital Center Monday, October 10, 2017 Pulmonary Artery
More informationEchocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016
Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative
More informationLV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital
LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload
More informationHISTORY. Question: What type of heart disease is suggested by this history? CHIEF COMPLAINT: Decreasing exercise tolerance.
HISTORY 15-year-old male. CHIEF COMPLAINT: Decreasing exercise tolerance. PRESENT ILLNESS: A heart murmur was noted in childhood, but subsequent medical care was sporadic. Easy fatigability and slight
More informationNEW GUIDELINES. A Guideline Protocol for the Assessment of Aortic Regurgitation From the British Society of Echocardiography Education Committee
NEW GUIDELINES A Guideline Protocol for the Assessment of Aortic Regurgitation From the British Society of Echocardiography Education Committee Gill Wharton, Prathap Kanagala (Lead Authors) Richard Steeds
More informationImaging Assessment of Aortic Stenosis/Aortic Regurgitation
Imaging Assessment of Aortic Stenosis/Aortic Regurgitation Craig E Fleishman, MD FACC FASE The Heart Center at Arnold Palmer Hospital for Children, Orlando SCAI Fall Fellows Course 2014 Las Vegas Disclosure
More informationEchocardiographic Evaluation of Aortic Valve Prosthesis
Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Co-Director, Echocardiography, Director, Interventional Cardiology Research, Beaumont Health System
More informationDisclosures Rebecca T. Hahn, MD, FASE
The New ASE Guidelines for Native Valvular Regurgitation Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR (With caveats and comments from R. Hahn) William A. Zoghbi MD, FASE, MACC Professor
More informationPART II ECHOCARDIOGRAPHY LABORATORY OPERATIONS ADULT TRANSTHORACIC ECHOCARDIOGRAPHY TESTING
PART II ECHOCARDIOGRAPHY LABORATORY OPERATIONS ADULT TRANSTHORACIC ECHOCARDIOGRAPHY TESTING STANDARD - Primary Instrumentation 1.1 Cardiac Ultrasound Systems SECTION 1 Instrumentation Ultrasound instruments
More informationAdel Hasanin Ahmed 1
Adel Hasanin Ahmed 1 PERICARDIAL DISEASE The pericardial effusion ends anteriorly to the descending aorta and is best visualised in the PLAX. PSAX is actually very useful sometimes for looking at posterior
More informationHeart sounds and murmurs. Dr. Szathmári Miklós Semmelweis University First Department of Medicine 15. Oct
Heart sounds and murmurs Dr. Szathmári Miklós Semmelweis University First Department of Medicine 15. Oct. 2013. Conditions for auscultation of the heart Quiet room Patient comfortable Chest fully exposed
More information«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer
«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Université LAVAL
More informationDECLARATION OF CONFLICT OF INTEREST. No disclosures
DECLARATION OF CONFLICT OF INTEREST No disclosures Congenital Aortic Valve Disease and Aortopathy: Recent Advances Sub- and Supravalvular Aortic Stenosis Westfälische Wilhelms-Universität Münster Helmut
More informationCardiology. the Sounds: #7 HCM. LV Outflow Obstruction: Aortic Stenosis. (Coming Soon - HCM)
A Cardiology HCM LV Outflow Obstruction: Aortic Stenosis (Coming Soon - HCM) the Sounds: #7 Howard J. Sachs, MD www.12daysinmarch.com E-mail: Howard@12daysinmarch.com Aortic Valve Disorders Stenosis Regurgitation
More information25 different brand names >44 different models Sizes mm
Types of Prosthetic Valves BIOLOGIC STENTED Porcine xenograft Pericardial xenograft STENTLESS Porcine xenograft Pericardial xenograft Homograft (allograft) Autograft PERCUTANEOUS MECHANICAL Bileaflet Single
More informationChoose the grading of diastolic function in 82 yo woman
Question #1 Choose the grading of diastolic function in 82 yo woman E= 80 cm/s A= 70 cm/s LAVI < 34 ml/m 2 1= Grade 1 2= Grade 2 3= Grade 3 4= Normal 5= Indeterminate 2018 MFMER 3712003-1 Choose the grading
More informationA Health Care Professional s Guide Aortic Stenosis in Seniors
A Health Care Professional s Guide Aortic Stenosis in Seniors With highlights from the 2014 ACC/AHA practice guidelines for valve disease Aortic stenosis (AS) is primarily caused by calcification of the
More informationDiastolic Function Assessment New Guideline Update Practical Approach
Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Diastolic Function Assessment New Guideline Update Practical Approach Jae K.
More informationTricuspid and Pulmonic Valve Disease
Chapter 31 Tricuspid and Pulmonic Valve Disease David A. Tate Acquired disease of the right-sided cardiac valves is much less common than disease of the leftsided counterparts, possibly because of the
More informationLeft Ventricular Assist Device: What Should I Report?
2017 SOTA, Tucson, AZ February 21, 2017 11:15 11:40 AM 25 min Left Ventricular Assist Device: What Should I Report? Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate Professor
More informationUpdate on Evaluation and Nonsurgical Treatment Strategies for the Symptomatic Patient with HCM
Update on Evaluation and Nonsurgical Treatment Strategies for the Symptomatic Patient with HCM Richard G. Bach, MD, FACC, FAHA Professor of Medicine Director, Hypertrophic Cardiomyopathy Center Washington
More informationStructural Heart Disease Transcatheter Aortic Valve Replacement (TAVR)
Structural Heart Disease Transcatheter Aortic Valve Replacement (TAVR) Kathleen Harper DO FACC FACP 87 Chief, Cardiology Section VA Maine Healthcare Kathleen.Harper@va.gov Prevalence of Aortic Stenosis
More informationLow Gradient AS Normal LVEF
Low Gradient AS Normal LVEF Shahbudin H. Rahimtoola MB, FRCP, MACP, MACC, FESC, D.Sc.(Hon) Distinguished Professor University of Southern California Griffith Professor of Cardiology Professor of Medicine
More information