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1) What is the most common cause of AS?
1) BAV with superimposed calcification or calcification and rheumatic changes in tricuspid valves.
Note - BAV's account for 50% of the reason for an AVR
3) Most often = fusion of RCC and LCC = large anterior and small post cusp.
80% = both CAs arise from the anterior leaflet, 20% = RCC and NCC fusion
rare = LCC and NCC fusion
- only 2 commissures and only 2 cusps seen in systole
* Raphe = fusion line where 2 cusps join
4) Calcification focused at the central part of each cusp.
*mild - few areas of dense echo with little acoustic shadowing
mod - more areas of dense echo + shadowing
sev - extensive thickening and increased echogenisity with prominent acoustic shadowing
5) Characterised by commissural fusion, triangular orifice in sys, calcification along edges of leaflets, MV nearly always affected as well
* degen = middle of cusps affected
rheumatic = commissures and leaflet edges affected
6) The site of stenosis is base on the detection of increased velocities by CD or PW dop.
*Subvalvular - fixed discrete membrane of musc band = haemodyn's similar to obstruction at the leave of the valve
*dynamic - eg in HCM. Obstruction changes severity during vent ejection, prominent mid-late sys, obstruction varies with loading conditions
*supravalvular = rare, due to CHD's
9) * Antergrade sys vel across the narrowed AoV
* measured with peadoff CW probe
* suprasternal, right parasternal, apical 4C, subcostal, right supraclavicular
Note - for calculations always take window with the highest velocity
10) What is CD useful for?
11) What is CW used not PW?
10) Useful in detection of jet direction and orientation and to avoid MR signal when placing Doppler line of site.
11) higher signal to noise ratio, more sensitive, no aliasing with high velocities, smaller footprint = can get better windows and angulation
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