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60 years old overweight ( 180cm x 150kg) man came to ekko study for verification of aorta valve stenosis and vague flow over aorta valve. Max gradient 25mmHg. Is this Alfieri aorta valve type? In statu nascendi ?

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3 leaflets?

Wojtek Guzowski писал(а): ↑

Вт сен 25, 2018 8:17 pm

3 leaflets?

In my opinion yes

Do you mean double orifice AV? I heard only about double orifice MV after edge-to-edge repair (Alfieri's procedure)
this is the way how eponymous borns)

Is it inherited ? or it may be a perforation due to endocarditis or trauma.
Has he aortic insufficiency?

nikolan70 писал(а): ↑

Сб сен 29, 2018 7:20 pm

Do you mean double orifice AV? I heard only about double orifice MV after edge-to-edge repair (Alfieri's procedure)
this is the way how eponymous borns)

Is it inherited ? or it may be a perforation due to endocarditis or trauma.
Has he aortic insufficiency?

Yes double orificeAV. I don't know if this is iherited (congenital) i think it is acquired. It looks like leak between rignt and left - coronary cusps in comissure. I don't think this is perforation, but clearly two separate orifice like in this exemple :

Thank you! Nice picture! Rare case!

Two orifices are the rare reason of stenosis severity overestimation

In AS cases two orifices are better then one!

https://scmr.org/page/COW1209?

NB direct planimetry in bicuspid valve leads to overestimation of effective orifice area because of "doming"

nikolan70 писал(а): ↑

Сб сен 29, 2018 8:35 pm

Thank you! Nice picture! Rare case!

Two orifices are the rare reason of stenosis severity overestimation

In AS cases two orifices are better then one!

https://scmr.org/page/COW1209?

NB direct planimetry in bicuspid valve leads to overestimation of effective orifice area because of "doming"

Therefor 3D

3d is better, but it is also operator depended, optimal angulation is needed. And massive calcification is the second limitation.

nikolan70 писал(а): ↑

Сб сен 29, 2018 10:07 pm

3d is better, but it is also operator depended, optimal angulation is needed. And massive calcification is the second limitation.

Yeas, exactly. I give here one of an example of 3D imaging paradox. This is a patient with Medtronic Hall mechanical valve. Observer is sitting in the aorta root (without seen hook) or in LVOT (seen hook) and looks across aortic valve. In systole, open valve flap obscures a cross view ( UL rays have only top-down approach) and it doesn’t help that we have done 3D reconstruction - in systole in 3D observer has an impression / ilusion that there is an obstacle in the aorta. The similar in diastole: mechanical valve flap is so tiny and parallel to UL rays that is not seen of machine and it gives rise to illusion that there is nothing in aorta in diastole, that means - it gives an ilusion that valve is open in diastole… First time I was thinking halve a day on it

Medtronic Hall