Cardiac  imaging  in    valvular  heart  disease  

•     Morphological  and  func6onal  anatomy  

•     Quan6fica6on  of  dysfunc6on  

•     Hemodynamic  impact  of  VHD  

•     Therapeu6c  and  prognos6c  implica6ons:  6ming  interven6on  

•   Guiding  therapy:  surgical  or  percutaneous  interven6ons  

Cardiac  imaging  in  VHD  

Normal  valvular  echo:  mitral  valve  

Abnormal Mitral Valve

Ecocardiografia Tridimensional

TTE: Echo anatomy of the TV

TEE: Mid-esophag. 4ch. view of TV

sept

ant

ant

post

sept

TEE: Transgastric transv. view of TV

Normal  valvular  echo:  aor6c  valve  

Vahanian A et al Eur Heart J 2008

Aor6c  root  anatomy  

Valve morphology

Normal  valvular  echo:  pulmonary  valve  

Valve  Stenosis  

•   Doppler  :increased  transvalvular  gradient  •   Reduced  effec6ve  valvular  area  

gradiente medio: 6 mmHg

Estenosis mitral Doppler CW espectral

•   Pressure  half  6me  •   Mean  transvalvular  gradient  

Quan6fica6on  of  valve  stenosis  

PHT  220  ms  =  1  cm2  

Estenosis mitral planimetría

comisura post

comisura ant

Área : 1.2 cm2

VI

va

vp

Estenosis mitral planimetría

Gradación estenosis mitral

Quantification of aortic stenosis

Area (cm2)

Area/BSA (cm2/m2)

Mean ∆P (mmHg)

V max (m/s)

Mild > 1,5 > 1,0 > 25 < 3

Moderate 1,0-1,5 0,6-1,0 25-50 3-4

Severe < 1,0 < 0,6 > 50 > 4

Bonow ACC/AHA Guidelines 2006 Vahanian A et al. ESC Guidelines, 2007

Valve  Regurgita6on  

Turbulent    abnormal  flow  (non-­‐laminar)  

 

Evaluación IM: Doppler Color

Spain MG et al. J Am Coll Cardiol 1989;13:585. Castelló R et al. J Am Coll Cardiol 1992;19:1516

ligera < 4 cm2 severa > 8 cm2

insuficiencia mitral

Ligera Severa

Grading  of  AR:  Methodology  

•   Mild  AR:  jet  diameter  <30%  LVOT  width  •   Moderate  AR:    jet  diameter  30-­‐50%  LVOT  width  •   Severe  AR:  jet  diameter  >  50%  LVOT  width  

Assessment of MR: Color Doppler jet area

Spain MG et al. J Am Coll Cardiol 1989;13:585. Castelló R et al. J Am Coll Cardiol 1992;19:1516

mild < 4 cm2 severe > 8 cm2

Assessment of VR: Color Doppler jet area

Advantages

EASY

•  Simple

•  Quick

•  Easy interpretation

•  Spatio-temporal direction of jet

Volumetric methods: -  Quantitative Doppler -  2D echo

Direct methods: - PISA

Quantitative methods to assess VR

 

 « Recommendations for evaluation of the severity of native valvular regurgitation with 2D and Doppler echocardiography » Zoghbi et al. Eur J Echocardiography.2003;4:237-61

GRADE Regurg. Vol. (ml/beat)

Regurg. Fraction (%)

ROA (mm2)

I < 30 < 30 < 20

II 30-45 30-50 20-35

III 45-60 50-60 35-45

IV >60 >60 > 45

Organic MR

Mitral  mechanical  prosthesis:  TTE  

Mitral  mechanical  prosthesis:  TEE  

Doppler/hemodynamic  profile  

2D  echo  bioprosthesis  

 •  Anterior  dehiscence  near  leZ  atrial  appendage  

Paravalvular  Leaks:  Abnormal  

Normally functioning valve prosthesis?