Valvular Heart Disease Excerpt CSOC

Diagnostic Evaluation: Echocardiography

• Echo is the primary and essential diagnostic test for diagnosis and assessment of the heart valves. The choice between transthoracic (TTE) and transesophageal (TEE) typically depends on what information the surgeon is trying to assess.

• TTE is the standard option for normal valve evaluation when assessing leaflet mobility, flexibility, thickness, calcification, and commissures.

• TEE is more common when evaluating patients with endocarditis to have a better view of the valve leaflets and the vegetation.

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Transesophageal Probe Placement

Diagnostic Evaluation: Echocardiography

Viewpoint for a transthoracic (TTE) image

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Transesophageal Probe Placement

Diagnostic Evaluation: Echocardiography

• Echo uses ultrasound to create the images you see on a screen. Most echo images will be in 2-dimensional (2-D) with some color-flow mapping. Some echo machines have the capability to transmit 3-dimensional (3-D) images.

• Color-flow mapping is important to view blood flow through the valves. It is very helpful in determining the severity of regurgitation. Flow toward the transducer is red while flow away from the transducer is blue. Flow with higher velocities will be lighter shades then flow with lower velocities.

Diagnostic Evaluation: Echocardiography

• In this image, you are looking at the AV during diastole. Blood is flowing back into the left ventricle (red).

• Echo images also allow the reader to gather measurements of the heart to further quantify abnormalities.

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Diagnostic Evaluation: Echocardiography

• In addition to obtaining measurements, echo imaging is also useful for assessing how the heart is functioning. In relation to valvular disease, you can assess for presence of ventricular hypertrophy (LVH) or dilation (DCM), diastolic dysfunction, or atrial enlargement.

• These findings can help you determine severity and chronicity of the valvular issues and any complications from long term valvular issues such as pulmonary hypertension.

Diagnostic Evaluation: Echocardiography

• Here you can see muscle thickness consistent with left ventricular hypertrophy as well as a rhematic mitral valve on autopsy.

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Diagnostic Evaluation: Echocardiography