Classification of valve stenosis and regurgitation: Difference between revisions
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Revision as of 02:32, 11 May 2022
Aortic Valve
Aortic valve stenosis - severity
Aortic sclerosis | Mild | Moderate | Severe | |
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Aortic jet velocity (m/s) | ≤2.5 m/s | 2.6-2.9 | 3.0-4.0 | >4.0 |
Mean gradient (mmHg) | - | <20 (<30a) | 20-40b (30-50a) | >40b (>50a) |
AVA (cm2) | - | >1.5 | 1.0-1.5 | <1 |
Indexed AVA (cm2/m2) | >0.85 | 0.60-0.85 | <0.6 | |
Velocity ratio | >0.50 | 0.25-0.50 | <0.25 | |
Aortic regurgitation - severity
Mild | Moderate | Severe | ||
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Specific signs for AR severity |
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Supportive signs |
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Quantitative parametersψ | ||||
R Vol, ml/beat | < 30 | 30-44 | 45-59 | ≥ 60 |
RF % | < 30 | 30-39 | 40-49 | ≥ 50 |
EROA, cm2 | < 0.10 | 0.10-0.19 | 0.20-0.29 | ≥ 0.30 |
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Mitral Valve
Mitral regurgitation - severity
Mild | Moderate | Severe | ||
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Specific signs of severity |
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Supportive signs |
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Quantitative parametersφ | ||||
R Vol (ml/beat) | < 30 | 30-44 | 45-59 | ≥ 60 |
RF (%) | < 30 | 30-39 | 40-49 | ≥ 50 |
EROA (cm2) | < 0.20 | 0.20-0.29 | 0.30-0.39 | ≥ 0.40 |
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Mitral stenosis - severity
Mild | Moderate | Severe | |
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Specific findings | |||
Valve area (cm2) | >1.5 | 1.0-1.5 | <1.0 |
Supportive findings | |||
Mean gradient (mmHg)a | <5 | 5-10 | >10 |
Pulmonary artery pressure (mmHg) | <30 | 30-50 | >50 |
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Mitral valve stenosis - Wilkins score
Grade | Mobility | Thickening | Calcification | Subvalvular Thickening |
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1 | Highly mobile valve with only leaflet tips restricted | Leaflets near normal in thickness (4-5 mm) | A single area of increased echo brightness | Minimal thickening just below the mitral leaflets |
2 | Leaflet mid and base portions have normal mobility | Midleaflets normal, considerable thickening of margins (5-8 mm) | Scattered areas of brightness confined to leaflet margins | Thickening of chordal structures extending to one-third of the chordal length |
3 | Valve continues to move forward in diastole, mainly from the base | Thickening extending through the entire leaflet (5-8mm) | Brightness extending into the mid-portions of the leaflets | Thickening extended to distal third of the chords |
4 | No or minimal forward movement of the leaflets in diastole | Considerable thickening of all leaflet tissue (>8-10mm) | Extensive brightness throughout much of the leaflet tissue | Extensive thickening and shortening of all chordal structures extending down to the papillary muscles |
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Mitral stenosis - routine measurements
Data element | Recording | Measurement |
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Planimetry | ||
- 2D parasternal short-axis view | - contour of the inner mitral orifice | |
- determine the smallest orifice by scanning from apex to base | - include commissures when opened | |
- positioning of measurement plan can be oriented by 3D echo | - in mid-diastole (use cine-loop) | |
- lowest gain setting to visualize the whole mitral orifice | - average measurements if atrial fibrillation | |
Mitral flow | ||
- continuous-wave Doppler | - mean gradient from the traced contour of the diastolic mitral flow | |
- apical windows often suitable (optimize intercept angle) | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear) | |
- adjust gain setting to obtain well-defined flow contour | - average measurements if atrial fibrillation | |
Systolic pulmonary artery pressure | ||
- continuous-wave Doppler | - maximum velocity of tricuspid regurgitant flow | |
- multiple acoustic windows to optimize intercept angle | - estimation of right atrial pressure according to inferior vena cava diameter | |
Valve anatomy | ||
- parasternal short-axis view | ||
- valve thickness (maximum and heterogeneity) | ||
- parasternal long-axis view | ||
- valve thickness | ||
- apical two-chamber view | ||
- subvalvular apparatus (chordal thickening, fusion, or shortening) | ||
Detail each component and summarize in a score |
Tricuspid Valve
Tricuspid regurgitation - severity
Parameter | Mild | Moderate | Severe |
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Tricuspid valve | Usually normal | Normal or abnormal | Abnormal/Flail leaflet/Poor coaptation |
RV/RA/IVC size | Normal∗ | Normal or dilated | Usually dilated∗∗ |
Jet area-central jets (cm2)§ | < 5 | 5-10 | > 10 |
VC width (cm)Φ | Not defined | Not defined, but < 0.7 | > 0.7 |
PISA radius (cm)ψ | ≤ 0.5 | 0.6-0.9 | > 0.9 |
Jet density and contour–CW | Soft and parabolic | Dense, variable contour | Dense, triangular with early peaking |
Hepatic vein flow† | Systolic dominance | Systolic blunting | Systolic reversal |
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Tricuspid stenosis - severity
Specific findings | |
Mean pressure gradient | ≥5 mmHg |
Inflow time-velocity integral | >60 cm |
T1/2 | ≥190 ms |
Valve area by continuity equationa | ≤1 cm2 |
Supportive findings | |
Enlarged right atrium ≥moderate | |
DHated inferior vena cava | |
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Pulmonary Valve
Pulmonary regurgitaion - severity
Parameter | Mild | Moderate | Severe |
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Pulmonic valve | Normal | Normal or abnormal | Abnormal |
RV size | Normal∗ | Normal or dilated | Dilated |
Jet size by color Doppler§ | Thin (usually < 10 mm in length) with a narrow origin | Intermediate | Usually large, with a wide origin; May be brief in duration |
Jet density and deceleration rate –CW† | Soft; Slow deceleration | Dense; variable deceleration | Dense; steep deceleration, early termination of diastolic flow |
Pulmonic systolic flow compared to systemic flow –PWφ | Slightly increased | Intermediate | Greatly increased |
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Pulmonary stenosis - severity
Mild | Moderate | Severe | |
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Peak velocity (m/s) | <3 | 3-4 | >4 |
Peak gradient (mmHg) | <36 | 36-64 | >64 |