Valve Regurgitation

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Valve Regurgitation

• Echocardiographic Calculations
• Rami Khouzam, MD

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Definitions/Equations

• Continuity equation
• Flow (SV) LVEDV - LVESV
• A x TVI
• (SVStroke Volume, A Area, TVITime Velocity
  Integral)
• Flow 1(SV) Flow 2 (SV)
• A1 x TVI 1 A2 x TVI2

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TVI

• Time Velocity Integral stroke distance (cm).
• The distance over which blood travels in one
  cardiac cycle the cycle velocity (cm/s) divided
  by time (s). Usually represents Mean gradient.
• Different than V (Velocity) m/s or cm/s.
• Usually represents Peak Instantaneous gradient.

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Area

• Area ? r2
• 3.14 r2 (radius)
• 0.785 d2 (diameter)

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• Flow 1(SV) Flow 2 (SV)
• A1 x TVI 1 A2 x TVI2
• Inflow Outflow
• A(MV) x TVI(MV) A(LVOT) x TVI(LVOT)

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Regurgitant Volume

• Regurgitant Volume (mL)
• SV (Valve) - SV (systemic)
• Regurgitant Fraction
• Regurgitant Fraction ()
• SV (Valve) - SV (systemic) / SV (Valve)

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Examples

• Mitral Regurgitation
• d(MV) 3.5 cm d(LVOT) 2.0 cm
• TVI (MV) 10 cm TVI (LVOT) 20 cm
• Calculate the Regurgitant Volume?
• A(MV) x TVI(MV) - A(LVOT) x TVI(LVOT)
• 96 - 62
• 34 mL

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• Aortic Regurgitation
• d(MV) 3.5 cm d(LVOT) 2.5 cm
• TVI (MV) 8 cm TVI (LVOT) 25 cm
• Calculate the Regurgitant Volume?
• A(LVOT) x TVI(LVOT) - A(MV) x TVI(MV)
• 122 - 76
• 46 mL

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ERO

• Effective Regurgitant Orifice area (cm2)
• Regurgitant Volume (mL) / TVI MR (cm)
• Effective Regurgitant Orifice area (cm2)
• Flow (mL/s) / V MR (cm/s)

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Example

• Mitral Regurgitation
• d(MV) 3.5 cm d(LVOT) 2.0 cm
• TVI (MV) 10 cm TVI (LVOT) 20 cm
• TVI (MR) 120 cm
• ERO (cm2) RV (mL) / TVI MR (cm)
• 34/120
• 0.28 cm2
• 28 mm2

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• Aortic Regurgitation
• d(MV) 3.5 cm d(LVOT) 2.5 cm
• TVI (MV) 8 cm TVI (LVOT) 25 cm
• TVI (AR) 188 cm
• ERO (cm2) RV (mL) / TVI AR (cm)
• 46/188
• 0.38 cm2
• 38 mm2

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Tips

• Inflow gt Outflow MR
• Inflow lt Outflow AR

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What is SEVERE Regurgitation?
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More Examples

• A 65 yo M with NYHA class II symptoms. EF 55 .
• d MV 4 cm d LVOT 2 cm
• TVI MV 10 cm TVI LVOT 20 cm
• V Ao 1.2
  m/s
• Whats next?
• a) Operate for MR
• b) Operate for AR
• c) Observe MR
• d) Observe combined AS/AR

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• Regurgitant Volume?
• A(MV) x TVI(MV) - A(LVOT) x TVI(LVOT)
• 125.6 gt 62.8
• 62 mL
• Inflow gt Outflow MR
• Answer a

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• A patient has
• d MV 4 cm d LVOT 2.5 cm
• TVI MV 4 cm TVI LVOT 25 cm
• V Ao 2.5
• This patient should have
• a) Absent A2
• b) Opening snap
• c) Quinckes pulse
• d) Large V-wave
• e) Clubbing

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• A(MV) x TVI(MV) - A(LVOT) x TVI(LVOT)
• 50.2 lt 122.6
• 72 mL
• Inflow lt Outflow AR
• Answer c

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