In vivo analysis of aortic valve dynamics by transesophageal 3-dimensional echocardiography with high temporal resolution Michael Handke, MD, Gudrun.

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Presentation transcript:

In vivo analysis of aortic valve dynamics by transesophageal 3-dimensional echocardiography with high temporal resolution Michael Handke, MD, Gudrun Heinrichs, Dipl-Ing, Friedhelm Beyersdorf, MD, Manfred Olschewski, MSc, Christoph Bode, MD, Annette Geibel, MD The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 6, Pages 1412-1419 (June 2003) DOI: 10.1016/S0022-5223(02)73604-0

Figure 1 A, Dynamic changes in normal aortic valve. During the systole, the aortic orifice changes not only its size, but also its shape. In this example, the orifice takes an “intermediate” (between round and triangular) shape at the time of maximum opening. Later, there is a slow closing movement, and the form becomes clearly triangular. B, Corresponding area-time diagram. AOA, aortic orifice area. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 2 Determination of the time and velocity indices based on the area-time-diagram. AOA, aortic orifice area; A1, maximum orifice area; A2, difference between maximum orifice area and orifice area at the end of the slow closing movement; A3, orifice area at the end of the slow closing movement; T1, time to maximum valve opening; T2, time for the slow closing movement; T3, time for the rapid closing movement; V1, velocity of rapid valve opening; V2, velocity of slow closing movement; V3, velocity of rapid closing movement. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 3 Typical forms of aortic orifice during systolic movement: stellate, round, intermediate, triangular. The drawings are based on recorded data. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 4 A, Dynamic changes in a stenosed aortic valve during the systole. The valve is functionally bicuspid; left- and right coronary cusps are fused. The opening movement of the valve is lethargic compared with a normal valve. B, Corresponding area-time diagram. AOA, aortic orifice area. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 5 Imaging of the systolic motion pattern of the aortic valve in 3 patients of the study groups NL, CMP, and AS. AOA, aortic orifice area; NL, normal; CMP, cardiomyopathy; AS, aortic stenosis. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 6 A, Time to maximum valve opening in the 3 patient groups. Stenosed valves required significantly more time to maximum opening of the valve. B, Relationship between maximum orifice area and time to maximum opening. There was a highly significantly inverse correlation between the two parameters. AOA, aortic orifice area; CMP, cardiomyopathy, AS, aortic stenosis. **P < .01. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 7 A, Comparison of valve opening velocities in the 3 groups examined. In the patients with reduced left ventricular function, the valve opened more slowly. Stenosed aortic valves opened slowest. B, Relationship between maximum orifice area and opening velocity. A close and highly significant correlation is found between the two parameters. AOA, aortic orifice area; CMP, cardiomyopathy; AS, aortic stenosis. *P < .05; **P < .001. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)

Figure 8 Relationship between the maximum Doppler gradient and the time to maximum structural opening of the valve in patients with aortic stenosis. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1412-1419DOI: (10.1016/S0022-5223(02)73604-0)