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The Important of Trans-Thoracic and
Esophageal Echocardiography in
Assessing Valvular Heart Disease
Achmad Lefi
 DISCLOSURE STATEMENT OF
FINANCIAL INTEREST

• I, Achmad Lefi DO NOT HAVE A FINANCIAL

INTEREST/ARRANGEMENT OR AFFILIATION WITH ONE OR
MORE ORGANIZATIONS THAT COULD BE PERCEIVED AS A REAL
OR APPARENT CONFLICT OF INTEREST IN THE CONTEXT OF
THE SUBJECT OF THIS PRESENTATION.
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 Burden of Valvular Heart Disease
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 Valvular Heart Disease

Dean, K. & Borer, J.S., 2013. Etiology of Valvular Heart Disease

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in the 21st Century. Cardiology, 126, pp.139–152.

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 Valvular Heart Disease : etiology

Dean, K. & Borer, J.S., 2013. Etiology of Valvular Heart Disease

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in the 21st Century. Cardiology, 126, pp.139–152.

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 Echo anatomy and etiology of VHD
•
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 Modalities of Echocardioraphy in VHD
• 2 D and 3 D imaging
• Doppler Evaluation of Severity of Valve Disease (Valve
stenosis and/or regurgitation)
• Speckle Tracking Strain Imaging
• Other Doppler Data (LV diastolic function, pulmonary
pressure at rest and with exercise
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 Echo evaluation in VHD
• Echocardiography Valve Anatomy
• Evaluation of Stenosis severity
• Evaluation of Valvular regurgitation
• Evaluation of Left ventricular geometry and Function
• Evaluation of Left atrial and thrombus formation
• Determination of Pulmonary pressures
• Right heart structure and Function
• Aortic anatomy and dilatation
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 TTE vs TEE : Morphology of VHD
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 Evaluation of valvular stenosis
2 D and 3 D imaging
• 2 D and 3D valve area
Doppler Evaluation
• Maximum velocity
• Mean pressure gradient
• Valve area (contuinity equation and or pressure half time)
• Other measurement if needed
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 Mitral Valve area : Echo with different methodes
• Example of a Typical Rheumatic Mitral Stenosis

Example of a Typical Rheumatic Mitral Stenosis

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Wunderlich, N.C., Beigel, R. & Siegel, R.J., 2013. Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging.
JACC: Cardiovascular Imaging, 6(11), p.1191 LP-1205. Available at: http://imaging.onlinejacc.org/content/6/11/1191
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 Echo evaluation for regurgitation severity
• Vena contracta width
• CW Doppler signal
• Doppler flow reversal Vena contracta
Vena contracta

• Regurgitation volume and orifice area

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VC width (cm)
Mild < 0.3
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Moderate 0.3-0.7

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Severe > 0.7
 Aortic regurgitation severity by Echo
•
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 Evaluation of LV geometry and Function
GLS in Patients With Severe Primary MR and GLS in a Patient With Severe MS With Respect to a
Preserved LVEF Normal Subject
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 Dilatation of Left atrial, SEC and thrombus
formation

Left atrial
Left atrium Left atrium appendage with
thrombus

Left ventricle
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 Right heart structure and Function
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 Determination of Pulmonary pressures
The presence of PH in left-sided VHD is frequent and of high prognostic significance
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 Aortic anatomy and dilatation
Aortic stenosis ec Biscuspid Aortic valve

Aortic root dilatation

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 Predictor of outcome : role of Echo for VHD
• Anterior Mitral Leaflet Length as Predictor for Mitral Valve
Repair in a Rheumatic Population
• With a value of 18 mm/m2 or more, repair can be accomplished
in all cases (Gupta et al. 2010)
• Left Atrial Volume Is a Strong Predictor of Outcome in
Patients with Organic Mitral Regurgitation.
• LA-index ≥ 60 ml/m2, 5-year mortality (47.0 vs. 12.4%, p<0.0001)
and cardiac events (69.3 vs. 10.8%, P<0.0001) (Tourneau, TL,
2018)
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 Conclusion
• Important diagnostic tool for valve anatomy, etiology,
severity of stenosis and regurgitation and consequent of
valve disease
• Echocardiography evaluation has prognostic value before
and after intervension
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 THANK YOU
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 Validation of the severity index by cardiac
catheterization and Doppler
echocardiography
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Timing for Intervension : role of Echo for VHD
• Anterior Mitral Leaflet Length as Predictor for Mitral Valve
Repair in a Rheumatic Population
• With a value of 18 mm/m2 or more, repair can be accomplished in all
cases (Gupta et al. 2010)
• Left Atrial Volume Is a Strong Predictor of Outcome in Patients
with Organic Mitral Regurgitation.
• LA-index ≥ 60 ml/m2, 5-year mortality (47.0 vs. 12.4%, p<0.0001) and
cardiac events (69.3 vs. 10.8%, P<0.0001) (Tourneau, TL, 2018)
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 Prognostication in VHD: role of Echo

Event-free survival according to mean pressure gradient (MPG) below or above 50mmHg (A) in the
subset of 61 patients with an aortic valve area (AVA)
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<1.0cm2 or (B) in the subset of 92 patients with a dimensionless index (DI) ≤0.25.

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 COLOR PALETTE
Color Scheme R G B
Background 255 255 255
Text and lines 0 0 0
Shadows 77 77 77
Title text 40 53 107
Fills 153 41 32
Accent 67 139 176
Accent and hyperlink 209 194 79
Accent and followed 150 150 150
hyperlink
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Grube E. et al, Am Journal Cardiol 2006; “in press”
 TABLE SLIDE
Subtitle text 40 pt Bold Italic

DCA Stent
P Value
n = 381 n = 372
Late loss (mm) 25.0 13.0 0.28
Binary restenosis 26.7 22.1 0.24
- Optimal DCA (%) 16.2 22.1 0.39
-TVR 25.0 23.0 21.0
12-Month TVF
23.9 21.5 0.48
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(death, MI, TVR) (%)

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 SAMPLE LINE CHART
Subtitle text 40 pt Bold Italic
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 PHOTO & BULLETED TEXT
• TEXT HERE
• TEXT HERE
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• TEXT HERE
• TEXT HERE
• TEXT HERE
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 DISCLOSURE STATEMENT
OF FINANCIAL INTEREST
• Within the past 12 months, I or my spouse/partner have had a financial
interest/arrangement or affiliation with the organization(s) listed below.

Affiliation/Financial Relationship Company

• Grant/Research Support • Company One
• Consulting Fees/Honoraria • Company Two
• Major Stock Shareholder/Equity • Company Three
• Royalty Income • Company Four
• Ownership/Founder • Company Five
•
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• Intellectual Property Rights Company Six

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 Impact of Echocardioraphy in Valvular Heart
Disease
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 Severity and grading of VHD : role of
Echocardiography
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highlight color
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paragraph
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• Speaker may use one of background colors
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