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The Important of Trans-Thoracic and
Esophageal Echocardiography in
Assessing Valvular Heart Disease
Achmad Lefi
DISCLOSURE STATEMENT OF
FINANCIAL INTEREST
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9 SURABAYA
CARDIOLOGY
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Burden of Valvular Heart Disease
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Valvular Heart Disease
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Valvular Heart Disease : etiology
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Echo anatomy and etiology of VHD
•
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Modalities of Echocardioraphy in VHD
• 2 D and 3 D imaging
• Doppler Evaluation of Severity of Valve Disease (Valve
stenosis and/or regurgitation)
• Speckle Tracking Strain Imaging
• Other Doppler Data (LV diastolic function, pulmonary
pressure at rest and with exercise
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Echo evaluation in VHD
• Echocardiography Valve Anatomy
• Evaluation of Stenosis severity
• Evaluation of Valvular regurgitation
• Evaluation of Left ventricular geometry and Function
• Evaluation of Left atrial and thrombus formation
• Determination of Pulmonary pressures
• Right heart structure and Function
• Aortic anatomy and dilatation
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TTE vs TEE : Morphology of VHD
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Evaluation of valvular stenosis
2 D and 3 D imaging
• 2 D and 3D valve area
Doppler Evaluation
• Maximum velocity
• Mean pressure gradient
• Valve area (contuinity equation and or pressure half time)
• Other measurement if needed
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Mitral Valve area : Echo with different methodes
• Example of a Typical Rheumatic Mitral Stenosis
Wunderlich, N.C., Beigel, R. & Siegel, R.J., 2013. Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging.
JACC: Cardiovascular Imaging, 6(11), p.1191 LP-1205. Available at: http://imaging.onlinejacc.org/content/6/11/1191
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Echo evaluation for regurgitation severity
• Vena contracta width
• CW Doppler signal
• Doppler flow reversal Vena contracta
Vena contracta
VC width (cm)
Mild < 0.3
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Moderate 0.3-0.7
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Severe > 0.7
Aortic regurgitation severity by Echo
•
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Evaluation of LV geometry and Function
GLS in Patients With Severe Primary MR and GLS in a Patient With Severe MS With Respect to a
Preserved LVEF Normal Subject
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Dilatation of Left atrial, SEC and thrombus
formation
Left atrial
Left atrium Left atrium appendage with
thrombus
Left ventricle
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Right heart structure and Function
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Determination of Pulmonary pressures
The presence of PH in left-sided VHD is frequent and of high prognostic significance
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Aortic anatomy and dilatation
Aortic stenosis ec Biscuspid Aortic valve
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Predictor of outcome : role of Echo for VHD
• Anterior Mitral Leaflet Length as Predictor for Mitral Valve
Repair in a Rheumatic Population
• With a value of 18 mm/m2 or more, repair can be accomplished
in all cases (Gupta et al. 2010)
• Left Atrial Volume Is a Strong Predictor of Outcome in
Patients with Organic Mitral Regurgitation.
• LA-index ≥ 60 ml/m2, 5-year mortality (47.0 vs. 12.4%, p<0.0001)
and cardiac events (69.3 vs. 10.8%, P<0.0001) (Tourneau, TL,
2018)
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Conclusion
• Important diagnostic tool for valve anatomy, etiology,
severity of stenosis and regurgitation and consequent of
valve disease
• Echocardiography evaluation has prognostic value before
and after intervension
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THANK YOU
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Validation of the severity index by cardiac
catheterization and Doppler
echocardiography
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Timing for Intervension : role of Echo for VHD
• Anterior Mitral Leaflet Length as Predictor for Mitral Valve
Repair in a Rheumatic Population
• With a value of 18 mm/m2 or more, repair can be accomplished in all
cases (Gupta et al. 2010)
• Left Atrial Volume Is a Strong Predictor of Outcome in Patients
with Organic Mitral Regurgitation.
• LA-index ≥ 60 ml/m2, 5-year mortality (47.0 vs. 12.4%, p<0.0001) and
cardiac events (69.3 vs. 10.8%, P<0.0001) (Tourneau, TL, 2018)
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Prognostication in VHD: role of Echo
Event-free survival according to mean pressure gradient (MPG) below or above 50mmHg (A) in the
subset of 61 patients with an aortic valve area (AVA)
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<1.0cm2 or (B) in the subset of 92 patients with a dimensionless index (DI) ≤0.25.
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COLOR PALETTE
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Background 255 255 255
Text and lines 0 0 0
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Title text 40 53 107
Fills 153 41 32
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hyperlink
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Grube E. et al, Am Journal Cardiol 2006; “in press”
TABLE SLIDE
Subtitle text 40 pt Bold Italic
DCA Stent
P Value
n = 381 n = 372
Late loss (mm) 25.0 13.0 0.28
Binary restenosis 26.7 22.1 0.24
- Optimal DCA (%) 16.2 22.1 0.39
-TVR 25.0 23.0 21.0
12-Month TVF
23.9 21.5 0.48
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SAMPLE LINE CHART
Subtitle text 40 pt Bold Italic
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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.
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Severity and grading of VHD : role of
Echocardiography
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highlight color
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paragraph
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