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ASSESSMENT OF MULTIVALVULAR LESION

ASSESSMENT OF MULTIVALVULAR LESION. MULTIVALVE LESION. Understand the hemodynamics volume & rate of flow pressure gradients assess the influence of one lesion on the other. MULTIVALVE LESION. Aortic stenosis vs mitral stenosis Aortic stenosis vs mitral regurgitation

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ASSESSMENT OF MULTIVALVULAR LESION

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  1. ASSESSMENT OF MULTIVALVULAR LESION

  2. MULTIVALVE LESION • Understand the hemodynamics • volume & rate of flow • pressure gradients • assess the influence of one lesion on the other

  3. MULTIVALVE LESION • Aortic stenosis vs mitral stenosis • Aortic stenosis vs mitral regurgitation • Aortic regurgitation vs mitral stenosis • Aortic regurgitation vs mitral regurgitation • influence of tricuspid lesions

  4. Aortic stenosis vs mitral stenosis

  5. AS vs MS LVDP is elevated in presence of AS Reduction in transmitral gradient Reduces the intensity of murmur of MS

  6. AS vs MS AS – impaired relaxation prolonged isovolumic relaxation time long A2 – OS interval ; short murmur

  7. MULTIVALVE LESION AS vs MS LVDP is elevated in presence of AS Interferes with LA emptying Further elevation of LA pressure Aggravation of symptoms

  8. MULTIVALVE LESION AS vs MS • Aggravation of symptoms • Attenuation of auscultatory findings • long A2 – OS interval • short murmur

  9. MULTIVALVE LESION AS vs MS -- Echo MVA – calculation PHT -- rate of drop of mitral gradient is influenced by LV compliance In AS – LV compliance is reduced ; hence PHT is prolonged and the calculated valve area will be less Apply the principle of continuity equation

  10. MULTIVALVE LESION MS vs AS Hemodynamics of MS do not significantly modify those of AS In severe MS --- PAH and low C.O Attenuates the Aggravate the transaortic gradient symptoms

  11. MULTIVALVE LESION AR vs MS Austin Flint murmur vs MS Points favouring MS • loud S1 + OS • apical diastolic thrill • loud long murmur , presystolic accentuation • features of PAH • chronic severe PVC • presence of AF

  12. MULTIVALVE LESION AR vs MS AR ---  LVDP  transmitral gradient attenuation of findings of MS PHT -- can be prolonged due to LVDP overestimates the severity of MS Hence continuity equation to be applied for calculation of MV area MS doesn’t significantly alter the findings of AR

  13. AR vs MR In AR LVSP is high ; hence MR gets exaggerated MR – LV stroke vol. goes to LA and aorta ; forward SV reduces leading to decapitation of SBP Pulse , BP -- systolic decapitation in presence of MR DBP & pulse character are unaltered S2 - AR – A2 delayed ; MR –A2 earlier Murmur -- MR accentuated ; AR – no change

  14. Influence of tricuspid valve lesion • TR / TS -- reduces the RV output to PA • reduced LV input • Attenuates the findings of aortic & mitral lesions • Decompresses the LA --- partial relief of pulm. • congestion in mitral stenosis • Aggravates the symptoms of AS

  15. MULTIVALVE LESION Summary • With a clear understanding of the hemodynamics • the modifications of findings can be deducted • should have awareness of the limitations in • echo evaluation

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