Keterangan
Two-dimensional echocardiography (2D echo) is a vital diagnostic tool in the assessment of valvular heart disease. Visualization of Heart Structures: 2D echo provides real-time, high-quality images of the heart, enabling the assessment of heart chambers, valves, and adjacent structures. It allows precise visualization of the structure and function of heart valves, including the mitral, aortic, tricuspid, and pulmonic valves. 2D echo can measure the extent of valve narrowing (stenosis), helping determine the severity of the condition. It assesses the extent of blood leakage or regurgitation through the valves, aiding in the grading of regurgitant lesions. The technique provides insights into valve leaflet thickness, mobility, and any structural abnormalities that might affect valve function. 2D echo helps assess the impact of valvular disease on blood flow, cardiac chambers, and overall hemodynamics. It can measure ejection fraction, an important parameter that reflects the heart's pumping ability and can be affected by valvular disease.It allows for the monitoring of disease progression and response to treatment or surgical interventions over time.
Ringkasan
- Echocardiography, especially with color Doppler, is a cost-effective and portable technique for assessing cardiac valves. Valvular lesions manifest as obstructions (narrowing) or regurgitation (leakage). Mitral and aortic valves are primary focus, though tricuspid and pulmonic valves can also be involved.
- Mitral stenosis can be graded as mild, moderate, or severe based on the mitral valve area, measured via 2D or 3D echo. Doppler methods are used when the echo window is poor, but are less accurate when leakage is significant. Pressure half-time calculations and flow acceleration radius measurements offer alternative approaches for assessing mitral valve area.
- Mitral regurgitation severity is determined by regurgitant jet area, vena contracta width, and regurgitant volume calculations. The vena contracta, a narrowed portion of the jet, is a key marker; its width correlates with regurgitation severity. Retrograde flow in pulmonary veins indicates severe regurgitation.
- Aortic stenosis is evaluated using pressure gradients across the aortic valve and aortic valve area measurements. The aortic valve area, peak velocity, velocity ratio, mean pressure gradient, and indexed aortic valve area are used to classify aortic stenosis as mild, moderate, or severe.
- Aortic regurgitation is assessed by jet width relative to LV width, vena contracta width, and volumetric methods. Regurgitant volume and fraction indicate severity. Black flow in the descending aorta, observed via suprasternal view, suggests more than moderate aortic regurgitation. Pressure half-time is less accurate.
- Tricuspid regurgitation is assessed by jet area, vena contracta width, and flow acceleration radius. Hepatic vein flow patterns are indicative of severity. Dominant A-wave in the tricuspid inflow implies mild regurgitation, while a dominant E-wave suggests severe regurgitation. Pulmonic stenosis is classified based on peak velocity and pressure gradient. Pulmonic regurgitation is evaluated based on the PR jet area, width, and pressure half-time.
- Right ventricular performance in the context of valvular issues can be assessed by measuring size, using tapsi, tissue Doppler to measure systolic velocity, and FAC (fractional area change). 3D echo provides better RV ejection fraction calculation.
Contoh Sertifikat
Tentang Pembicara
Dr.KK Kapur
Konsultan Senior Kardiologi Intervensional, New Delhi, India
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