Norman H Silverman, MD, Doff B McElhinney, MD

Slides:

Advertisements

Similar presentations

Assessing the atrial septum

Advertisements

Fig 39 Tetralogy of Fallot.

Guidelines for the Echocardiographic Assessment of

Ventricular septal defects

Congenital mitral valve stenosis

Double inlet Left Ventricle Apical four chamber view showing double inlet left ventricle. Note the presence of two atrioventricular valves connecting to.

Transposition of Great Arteries Parasternal long axis view from a patient with transposition of the great arteries. Note the two great arteries are parallel.

Quantitative Real-Time Three-Dimensional Echocardiography Provides New Insight into the Mechanisms of Mitral Valve Regurgitation Post-Repair of Atrioventricular.

RICK A. NISHIMURA, M. D. , FLETCHER A. MILLER, M. D. , MARK J

Lindsay S. Rogers, MD, Amy L. Peterson, MD, J

LV A B C D E F G H r E A Online Figure E2

Use of Doppler Techniques (Continuous-Wave, Pulsed-Wave, and Color Flow Imaging) in the Noninvasive Hemodynamic Assessment of Congenital Heart Disease

Curious Case of Wheezing: Carcinoid Heart Disease

Regression of tricuspid regurgitation after two-stage arterial switch operation for failing systemic ventricle after atrial inversion operation Jacques.

Volume 18, Issue 4, Pages xvi-xxiii (November 2000)

Novel mechanism of mitral regurgitation after lung transplantation in a patient with scleroderma and pulmonary hypertension Christian A. Bermudez, MD,

Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy Mehul R. Bhatt, MD,

RICK A. NISHIMURA, M. D. , FLETCHER A. MILLER, M. D. , MARK J

Adrian P Banning, Aurangseb Durrani, Ravi Pillai

Echocardiography of hypoplastic ventricles

Aortico-Left Ventricular Tunnel: Diagnosis Based on Two-Dimensional Echocardiography, Color Flow Doppler Imaging, and Magnetic Resonance Imaging RICHARD.

Prosthetic Mitral Valve Replacement: Late Complications After Native Valve Preservation Eduardo Esper, MD, Francis D Ferdinand, MD, Solomon Aronson,

Prevalence and clinical significance of acquired left coronary artery fistulas after surgical myectomy in patients with hypertrophic cardiomyopathy Aurelio.

Intracoronary Shunt Prevents Ischemia in Off-Pump Coronary Artery Bypass Surgery Jacob Bergsland, MD, Per Snorre Lingaas, MD, Helge Skulstad, MD, PhD,

Cardiac Vagal Stimulation Eliminates Detrimental Tachycardia Effects of Dobutamine Used for Inotropic Support Youhua Zhang, MD, PhD, Todor N. Mazgalev,

Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique Carl L. Backer, MD, Robert D. Stewart, MD, Frédérique.

Timothy M. Colen, MBBS, Nee S. Khoo, MBChB, David B

Predicting Feasibility of Biventricular Repair of Right-Dominant Unbalanced Atrioventricular Canal Jacques A.M van Son, MD, PhD, Colin K Phoon, MPhil,

Klaus Langes, MD, Dietmar Koschyk, MD, Detlef G. Mathey, MD

Morphologic Spectrum of Ventriculoarterial Connection in Hearts With Double Inlet Left Ventricle: Implications for Surgical Procedures Hideki Uemura,

Surgically created double orifice repair of tricuspid regurgitation in infants with congenital heart disease Toyoki Fukuda, MD, Ichiro Kashima, MD, Shigeki.

Initial Experience With a Miniaturized Multiplane Transesophageal Probe in Small Infants Undergoing Cardiac Operations Sinai C. Zyblewski, MD, Girish.

Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects Emmeline.

Organized thrombus of the tricuspid valve mimicking valvular tumor

Which two ventricles cannot be used for a biventricular repair

A 74-Year-Old Man With Refractory Hypotension After Spine Surgery

Surgical intervention for complications of transcatheter dilation procedures in congenital heart disease Doff B McElhinney, MD, V.Mohan Reddy, MD, Phillip.

Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease Lina Maria Vargas Abello, MD, Allan.

Zohair Al Halees, MD, Mahmoud M. Awad, MD, Frans Pieters, MD, Maie S

Echocardiographic evidence of right ventricular remodeling after transplantation Holger K Eltzschig, MD, Tomislav Mihaljevic, MD, John G Byrne, MD, Raila.

Dissection of atrial septum after mitral valve replacement

Nihan Kayalar, MD, Hartzell V. Schaff, MD, Richard C

Ventricularization of the atrialized chamber: A concept of Ebstein's anomaly repair Michael V. Ullmann, MD, Sabine Born, MD, Christian Sebening, MD, Matthias.

Hemoptysis as a rare presentation of cor triatriatum sinister

Double-outlet right ventricle with complete atrioventricular canal

Radiofrequency catheter ablation for drug-refractory paroxysmal atrial fibrillation in a patient with Ebstein’s anomaly Yong-Giun Kim, MD, Shin-Jae Kim,

Samuel Z. Goldhaber, M.D. Mayo Clinic Proceedings

Stanley E. Rittgers, PhD, Mark C.S. Shu, PhD

Naruhito Watanabe, MD, Richard D. Mainwaring, MD, Sergio A

Sixty Years After Tetralogy of Fallot Correction

Surgical Results in Patients With Pulmonary Atresia-Major Aortopulmonary Collaterals in Association With Total Anomalous Pulmonary Venous Connection

Andrew Gogbashian, MD, Ravi K

Rapid progression of midventricular obstruction in adults with double-chambered right ventricle José María Oliver, MD, Ana Garrido, MD, Ana González,

Fistulous Pseudoaneurysm Complicating Surgical Accessory Pathway Interruption for Wolff-Parkinson-White Syndrome THOMAS L. SALAZER, M.D., J. MICHAEL.

Use of Doppler Techniques (Continuous-Wave, Pulsed-Wave, and Color Flow Imaging) in the Noninvasive Hemodynamic Assessment of Congenital Heart Disease

Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae V.Mohan Reddy, MD, Doff B McElhinney, MD, Michael M Brook, MD, Norman.

Tricuspid Valve Prolapse Diagnosed by Cross-Sectional Echocardiography

Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum Kothandam Sivakumar, MD, DM, Edwin Francis,

Late results of palliative atrial switch for transposition, ventricular septal defect, and pulmonary vascular obstructive disease Harold M Burkhart,

The mitral pulmonary autograft: assessment at midterm

P.Michael McFadden, John L Ochsner The Annals of Thoracic Surgery

Norwood Stage 1 With Surgical Ventricular Reconstruction and Mitral Valve Repair for Neonatal Idiopathic Left Ventricular Dilated Cardiomyopathy Patrick.

Localized Pericardial Hematoma Presenting With Acute Hypoxemia

Power loss and right ventricular efficiency in patients after tetralogy of Fallot repair with pulmonary insufficiency: Clinical implications Mark A.

Aorto-atrial fistula through the septum in recurrent aortic dissection

Young-Sang Sohn, MD, Christian P

Complete cavopulmonary shunt completion after in utero balloon atrial septoplasty for hypoplastic left heart syndrome Nicholas H. Von Bergen, MD, Harold.

Long-Term Follow-Up of the Conal Flap Method for Tricuspid Malinsertion in Transposition of the Great Arteries With Ventricular Septal Defect and Pulmonary.

Shaun P. Setty, MD, John L. Bass, MD, K. P

Divided Left Atrium (Cor Triatriatum) in the Setting of Common Atrium

Presentation transcript:

Atrioventricular valve dysfunction: evaluation by doppler and cross-sectional ultrasound Norman H Silverman, MD, Doff B McElhinney, MD The Annals of Thoracic Surgery Volume 66, Issue 2, Pages 653-658 (August 1998) DOI: 10.1016/S0003-4975(98)00583-9

Fig 1 (A) This diagram demonstrates the features of jet physics, which are important in the assessment of atrioventricular valve regurgitation. The jet in the lower part of the diagram can be seen to have multiple velocities in aliasing. Its length over its width is a constant of 6.3. The jet has a central core and has entrainment of mass as it decelerates (arrows). Proximal to the jet, the flow velocity accelerates along an isovelocity line related to the first alias. The area of the hemisphere formed by the isovelocity line of the first alias (2πr2), multiplied by the velocity of the Nyquist limit in cm/s (in this example, 38 cm/s), multiplied by 60 and divided by 1,000 to bring the equation to L/min, yields the volume flow of the regurgitant jet. Centerline velocities are the velocities along the jet length, which diminish with continuing entrainment of the jet. (B) An example of centerline velocities. It is known that a turbulent jet expands laterally as it flows because of surrounding fluid entrainment, which slows the jet velocity along its centerline relationship. Vo = velocity at the orifice of the jet; D = diameter of the orifice; Vm = centerline velocity at a given point X; and 6.3 = the constant relating the maximal jet width to length. The flow of the jet can then be related to the velocity measured in the centerline at a given position from the jet’s orifice divided by a constant, multiplied by the velocity at the orifice of the jet. (Top right) We can see the potential core decay for velocities beginning at 1 mm (A) and 2 mm (B and C), their decay levels at velocities starting off initially at 2 (A and B) and 4 m/s (C), respectively. (Bottom left) The relationship of the distal velocity to the orifice velocity at a given position related to the orifice diameter is equivalent for all curves (a, b, and c). (Bottom right) The reciprocal of this relationship, the relationship of the velocity at the orifice over the velocity distally, can be seen to exhibit a linear pattern for all different kinds of curves (a, b, and c). Thus, if one knows the distal velocity at any given relationship distance, one can calculate the flow through the orifice. The Annals of Thoracic Surgery 1998 66, 653-658DOI: (10.1016/S0003-4975(98)00583-9)

Fig 2 Apical four-chamber view in a patient with pulmonary hypertension. (Left) The right atrium (RA) and right ventricle (RV) are enlarged. (Middle) Doppler color-flow map with the flow disturbance in the atrium caused by the regurgitation. The velocity signal obtained axial to the jet velocity through the central core is 5.13 m/s, equivalent to a pressure difference between the right atrium and ventricle of 105 mm Hg. (LA = left atrium; LV = left ventricle.) The Annals of Thoracic Surgery 1998 66, 653-658DOI: (10.1016/S0003-4975(98)00583-9)

Fig 3 These series of figures demonstrate the variability of mapping jet size based on changes in various Doppler settings in the same patient as in Figure 2. (A) This figure shows different velocity maps of tricuspid regurgitation. In all of these examples, the Nyquist limit is set at 61, but different maps define different aspects. (Top left) A standard velocity map. (Top right) A velocity plus variance map. (Bottom left) A simple red-blue velocity map. (Bottom right) A different velocity variance map. Note particularly the isovelocity change proximal to the tricuspid regurgitation, which is not substantially altered with the respective maps. What appears to be altered is the distal processing of the jet in the atrium. (B) In this same patient, the standard velocity variance map is used, but the Nyquist limit is changed from 61 (top left) to 39 (top right) to 23 (bottom left) to 17 (bottom right). Note that not only does the jet broaden in the right atrium, but also the size of the alias boundary increases progressively. The Annals of Thoracic Surgery 1998 66, 653-658DOI: (10.1016/S0003-4975(98)00583-9)

Fig 3 These series of figures demonstrate the variability of mapping jet size based on changes in various Doppler settings in the same patient as in Figure 2. (A) This figure shows different velocity maps of tricuspid regurgitation. In all of these examples, the Nyquist limit is set at 61, but different maps define different aspects. (Top left) A standard velocity map. (Top right) A velocity plus variance map. (Bottom left) A simple red-blue velocity map. (Bottom right) A different velocity variance map. Note particularly the isovelocity change proximal to the tricuspid regurgitation, which is not substantially altered with the respective maps. What appears to be altered is the distal processing of the jet in the atrium. (B) In this same patient, the standard velocity variance map is used, but the Nyquist limit is changed from 61 (top left) to 39 (top right) to 23 (bottom left) to 17 (bottom right). Note that not only does the jet broaden in the right atrium, but also the size of the alias boundary increases progressively. The Annals of Thoracic Surgery 1998 66, 653-658DOI: (10.1016/S0003-4975(98)00583-9)

Fig 4 (A) Diagramatic representation of an apical four-chamber image in a patient with transposition of the great arteries and substantial tricuspid regurgitation before pulmonary artery banding. (Left) The dilated right ventricle with tricuspid regurgitation related to chordal position change. (Right) After the band is applied, the left and right ventricular areas change and the ventricular septal configuration is altered, shifting the location and orientation of the subvalvar apparatus of the tricuspid valve and also altering the zone of apposition of the tricuspid valvar leaflets. As a result, tricuspid valve regurgitation diminishes. (B) A series of four-chamber transesophageal views showing gradual tightening of the pulmonary artery band (from left to right and top to bottom) in a patient with right ventricular dysfunction and severe tricuspid regurgitation late after atrial repair of transposition of the great arteries. Note the shift in the position of the ventricular septum. (C) Doppler color-flow images in the same patient demonstrate a marked change in the tricuspid regurgitant velocity during the tightening of the band, as well as a significant decrease in tricuspid regurgitation. Left ventricular pressure was monitored to test the adequacy of the band from 40% to 90% of left ventricular pressure. (LV = left ventricle; PA = pulmonary artery; PVA = pulmonary venous atrium; RV = right ventricle; SVA = systemic venous atrium.) The Annals of Thoracic Surgery 1998 66, 653-658DOI: (10.1016/S0003-4975(98)00583-9)