Fixed-point property

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Aortic valve area calculation is an indirect method of determining the area of the aortic valve. The calculated aortic valve orifice area is currently one of the measures for evaluating the severity of aortic stenosis. A valve area of less than 0.8 cm² is considered to be severe aortic stenosis.[1][2]

There are many ways to calculate the valve area of aortic stenosis. The most commonly used methods involve measurements taken during echocardiography. For interpretation of these values, the area is generally divided by the body surface area, to arrive at the patient's optimal aortic valve orifice area.

Planimetry

Planimetry is the tracing out of the opening of the aortic valve in a still image obtained during echocardiographic acquisition during ventricular systole, when the valve is supposed to be open. While this method directly measures the valve area, the image may be difficult to obtain due to artifacts during echocardiography, and the measurements are dependent on the technician who has to manually trace the perimeter of the open aortic valve. Because of these reasons, planimetry of aortic valve is not routinely performed.

The continuity equation

The continuity equation states that the flow in one area must equal the flow in a second area if there are no shunts between the two areas. In practical terms, the flow from the left ventricular outflow tract (LVOT) is compared to the flow at the level of the aortic valve. In echocardiography the aortic valve area is calculated using the velocity time integral (VTI) which is the most accurate method and preferred. The flow through the LVOT, or LV Stroke Volume (cm3 or cc), can be calculated by measuring the LVOT diameter (cm), squaring that value, multiplying the value by 0.78540 giving cross sectional area of the LVOT (cm2)and multiplying that value by the LVOT VTI(cm), measured on the spectral Doppler display using pulsed-wave Doppler. From these, it is easy to calculate the area (cm2) of the aortic valve by simply dividing the LV Stroke Volume (cm3) by the AV VTI(cm) measured on the spectral Doppler display using continuous-wave Doppler.

SV = 0.785 x Diameter2 x VTI(LVOT)

CSA(LVOT)cm2 = 0.785 x LVOT Diameter

SV = Stroke Volume CSA = Cross sectional area

Aortic Valve Area (cm2)=LVOT diameter20.78540LVOT VTIAortic Valve VTI

Example: An individual undergoes transthoracic echocardiography for the evaluation of a systolic ejection murmur with delayed carotid upstroke noted on physical examination. During echocardiography, the following measurements were made: LVOT diameter of 2 cm, LVOT VTI of 24 cm, and an Aortic Valve VTI of 50 cm. What is the aortic valve area?
Answer: An LVOT diameter of 2 cm gives a LVOT cross-sectional area of, 2 * 2 * 0.78540 = 3.14 cm2. To calculate stroke volume, multiply the cross-sectional area of 3.14 cm2 by the LVOT VTI 24 cm. This gives an LV Stroke Volume of 3.14 * 24 = 75.40 cc. Divide the LV Stroke Volume, 75.40 cc by the Aortic Valve VTI, 50 cm and this gives an aortic valve area of 75.40 / 50 = 1.51 cm2.

The weakest aspect of this calculation is the variability in measurement of LVOT area, because it involves squaring the LVOT dimension. Therefore, it is crucial for the sonographer to take great care in measuring the LVOT diameter.

The measurement using echocardiogram may be inaccurate in cases of Aortic subvalvular stenosis, because there is not a uniform diameter, as assumed during echocardiogram. The viewpoint of the echocardiogram may distort the true diameter of the LVOT in some patients. For verification purposes of the obtained valve area using echocardiogram and doppler measures, especially if the obtained valve area is in the range requiring surgery and cardiac output is low, the Gold standard of left heart catheterization for true hemodynamics should be obtained for validation using the Gorlin formula, so patient does not go for unneeded surgery.

The Gorlin equation

The Gorlin equation states that the aortic valve area is equal to the flow through the aortic valve during ventricular systole divided by the systolic pressure gradient across the valve times a constant. The flow across the aortic valve is calculated by taking the cardiac output (measured in liters/minute) and dividing it by the heart rate (to give output per cardiac cycle) and then dividing it by the systolic ejection period measured in seconds per beat (to give flow per ventricular contraction).

Valve Area (cm2)=Cardiac Output (mlmin)Heart rate (beatsmin)Systolic ejection period (s)44.3mean Gradient (mmHg)

The Gorlin equation is related to flow across the valve. Because of this, the valve area may be erroneously calculated as stenotic if the flow across the valve is low (i.e. if the cardiac output is low). The measurement of the true gradient is accomplished by temporarily increasing the cardiac output by the infusion of positive inotropic agents, such as dobutamine.

Example: An individual undergoes left and right heart cardiac catheterization as part of the evaluation of aortic stenosis. The following hemodynamic parameters were measured. With a heart rate of 80 beats/minute and a systolic ejection period of 0.33 seconds, the cardiac output was 5 liters/minute. During simultaneous measurement of pressures in the left ventricle and aorta (with the use of one catheter in the left ventricle and a second in the ascending aorta), the mean systolic pressure gradient was measured at 50 mmHg. What is the valve area as measured by the Gorlin equation?
Answer: Aortic Valve Area=5000mlmin80beatsmin0.33s44.350mmHg0.6cm2

The Hakki equation

The Hakki equation[3] is a simplification of the Gorlin equation, relying on the observation that in most cases, the numerical value of heart rate (bpm)systolic ejection period (s)44.31000. The resulting simplified formula is:

Aortic Valve area (cm2)Cardiac Output(litremin)Peak to Peak Gradient (mmHg)

Example: An individual undergoes left and right cardiac catheterization for the evaluation of aortic stenosis. Measurements includes an aortic pressure of 120/60, LV pressure of 170/15, cardiac output of 3.5 liters/minute. What is the aortic valve area?
Answer: The peak gradient between the LV and aorta is 50 mmHg. This gives

Aortic valve area3.5500.5cm2

Real-time three-dimensional echocardiography

See http://circ.ahajournals.org/content/112/7/992

See also

https://www.google.com/search?q=Real-time+three-dimensional+echocardiography&sourceid=ie7&rls=com.microsoft:en-us:IE-SearchBox&ie=&oe=

References

43 year old Petroleum Engineer Harry from Deep River, usually spends time with hobbies and interests like renting movies, property developers in singapore new condominium and vehicle racing. Constantly enjoys going to destinations like Camino Real de Tierra Adentro.

Template:Cardiovascular physiology

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    In its statement, the singapore property listing - website link, government claimed that the majority citizens buying their first residence won't be hurt by the new measures. Some concessions can even be prolonged to chose teams of consumers, similar to married couples with a minimum of one Singaporean partner who are purchasing their second property so long as they intend to promote their first residential property. Lower the LTV limit on housing loans granted by monetary establishments regulated by MAS from 70% to 60% for property purchasers who are individuals with a number of outstanding housing loans on the time of the brand new housing purchase. Singapore Property Measures - 30 August 2010 The most popular seek for the number of bedrooms in Singapore is 4, followed by 2 and three. Lush Acres EC @ Sengkang

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    A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running

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