PMC5318985_01
(Case #1): Panel A shows continuous-wave interrogation of the aortic prosthesis in apical 5-chamber view. Panel B shows pulsed-wave Doppler spectrum of the left ventricular outflow tract. Panel C shows trans-esophageal long axis view for measuring the left ventricular outflow tract. The estimated aortic valve area by continuity equation was 0.72 cm2.
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His last echocardiographic examination was performed in February 2016 which showed peak and mean trans-prosthetic gradients of 74 and 43 mmHg respectively (velocity time integral of 110 cm) with estimated effective orifice area by continuity equation of 0.72 cm2 at a heart rate of 54 beats/min and normal flow rate of 300 mL/s (Table 1, Fig. 1).
(Case #1): Left panel shows wide trans-valvular orifice by color Doppler flow in cross-sectional transesophageal echocardiographic view. Estimated color flow area (panel B) during systole is 1.7 cm2. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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Geometric valve area measured using cross-sectional and 3D trans-esophageal echocardiography averaged 1.7 cm2 (Fig. 2, Fig. 3, Fig. 4).
(Case #1): 3D-transesophageal views from the left ventricular side. Valve orifice is triangular and measures 1.69 cm2.
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Geometric valve area measured using cross-sectional and 3D trans-esophageal echocardiography averaged 1.7 cm2 (Fig. 2, Fig. 3, Fig. 4).
(Case #2): Continuous-Doppler interrogation of the left ventricular outflow tract in apical view and pulsed-wave Doppler spectrum seen in inset. Trans-prosthetic peak velocity averaged 4 m/s and in the left ventricular outflow tract, it was 90 cm/s.
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Her latest echocardiographic examination performed in September, 2015 showed peak and mean trans-prosthetic pressure gradients of 64 and 36 mmHg (velocity time integral of 85 cm) and effective valve orifice area by continuity equation of 0.8 cm2 (Table 1 and Fig. 5).
(Case #2): Trans-esophageal echocardiographic long axis (panel A) and short axis (panel B) views showing 20 mm wide orifice of aortic prosthesis and oblong color flow area of 1.6 cm2.
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The valve leaflets were normal and opened seamless with an inter-leaflet distance of 20 mm during systole when examined by cross-sectional echocardiography (Fig. 6).
(Case #2): Trans-esophageal echocardiographic valve orifice area measured using cross-sectional 2D (panel A) and by 3D multiplanar reconstructed views (panel C). Panel B shows normally opening leaflets in long axis view. The orifice area averaged 1.6 cm2 and was oblong in shape.
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Average geometric orifice area by planimetry was 1.6 cm2 when measured from 3D multiplanar reconstructed images and cross-sectional images during early systole (Fig. 7).