Coronary artery disease with LV dysfunction and AR
Echocardiogram with video
M-mode echocardiogram at mitral valve level
M-mode echocardiogram at the level of mitral valve showing the early diastolic E wave and the atrial systolic A wave. The left ventricle (LV) is dilated and the left ventricular posterior wall (LVPW) contractions are reduced. The distance from the E point of the mitral valve and interventricular septum (IVS) is increased due to the poor excursions of the mitral valve on opening and the dilated left ventricle. The overall left ventricular function is reduced and there is regional wall motion abnormality suggestive of coronary artery disease.
Doppler tracing in aortic regurgitation
The continuous wave Doppler cursor is seen along the left ventricular outflow tract and the aorta. The upper panel shows the two dimensional image in the apical five chamber view showing all four cardiac chambers and the aorta. The colour flow mapping overlay shows the turbulent multicoloured mosaic jet in the left ventricular outflow tract just beneath the aortic valve suggestive of aortic regurgitation. The diastolic mitral flow is seen as a red colour in just beyond the mitral valve, in the left ventricle. The lower panel shows the Doppler tracing in aortic regurgitation (AR). The AR jet is upwards as it moves towards the transducer kept at the left ventricular apex. The small tracing below the baseline is the forward aortic flow, which is denser as it covers the whole forward cardiac output. The retrograde flow due to aortic regurgitation is fainter because the volume of aortic regurgitation is not severe.
Pressure half time in aortic regurgitation
Measurement of pressure half time in aortic regurgitation is used in assessing the severity of aortic regurgitation. It is inversely related to the severity of aortic regurgitation. The beginning of the diastolic tracing corresponds to the pressure difference between the aorta and the left ventricle in early diastole while the end of the tracing represents the end diastolic gradient. When the regurgitation is severe, there is rapid equalisation of the aortic and ventricular diastolic pressures. This causes the pressure half time to be shorter. Pressure half time is the time taken for the pressure difference to fall by half. In this case the pressure half time (P1/2) is high (712 msec) as the aortic regurgitation is not severe.