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

8. 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

9. Aortic stenosis vs mitral stenosis

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

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

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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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