Echo Normal Values for Echocardiography exams

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Quick Revision Points - Valvular Heart Disease

Table of contents
1. Valves
Aortic valve
1. Aortic stenosis
2. Aortic regurgitation
Mitral valve
1. Mitral stenosis
2. Mitral regurgitation
Tricuspid valve
1. Tricuspid stenosis
2. Tricuspid regurgitation
Pulmonary valve
1. Pulmonary stenosis
2. Pulmonary regurgitation
Right atrial pressure


1. Valves

Valve disease is commonly encountered in clinical practice, and forms one of the commonest
reasons for an echocardiogram. It is important to remember the common causes of various valvular
conditions and guidance on defining the severity of the lesion. The guidance below is based on British
Society of Echocardiography recommended values.





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Aortic valve
1. Aortic stenosis
Causes
● Bicuspid valve - common in Europe, usually associated with calcification
● Calcification
● Rheumatic heart disease - common in rest of the world

Evaluation
Parameter Normal Mild Moderate Severe
Peak Velocity (m/s) < 2.5 2.6 - 2.9 3.0 - 4.0 >4.0
Peak pressure drop (mmHg) - < 35 36 - 64 > 65
Mean pressure drop (mmHg) - < 25 25 - 40 > 40
Valve area (cm2) > 2.0 1.5 - 2.0 1.0 - 1.4 < 1.0

Critical valve stenosis = Valve area < 0.6 cm2
2. Aortic regurgitation

Causes
1. Valvular
a. Infective endocarditis
b. Rheumatic heart disease
c. Congenital bicuspid valve
d. Aortic valve calcification
e. Myxomatous degeneration of aortic valve

2. Aortic root
a. Dilated aortic root - Marfans syndrome, Ehler Danlos syndrome
b. Dilatation secondary to hypertension

Evaluation

Doppler parameter Mild AR Moderate AR Severe AR

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Pressure half time > 500 ms < 200 ms
Vena contracta < 0.3 cm > 0.6 cm
Jet width/LVOT < 25% > 65%
Regurgitant orifice area < 0.1 cm2 0.11 - 0.29 cm2 =/> 0.3 cm2
Aortic flow reversal early diastolic or none Holodiastolic
Regurgitant volume < 30 mL/beat 31 - 59 mL/beat =/> 60 mL/beat

Mitral valve
1. Mitral stenosis
Causes
● Rheumatic heart disease
Evaluation

Parameter Normal Mild Moderate Severe
Valve area (cm2) 4 - 6 1.6 - 2.0 1.0 - 1.5 < 1.0
Mean pressure gradient (mmHg) < 5 5 - 10 > 10
Pressure half time (ms) 40 - 70 71 - 139 140 - 219 > 220
Pulmonary artery pressure (mmHg) < 30 30 - 50 > 50
2. Mitral regurgitation
Causes
● Mitral valve prolapse
● Dilated cardiomyopathy
● Ischemic heart disease
● Papillary muscle rupture

Evaluation

Parameter Mild Moderate Severe
Jet area (cm2) < 4 > 10

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Vena Contracta (cm) < 0.3 >/= 0.7
PISA radius (Nyquist 40 cm/s) < 0.4 > 1.0
Regurgitant volume (mL) < 30 31 - 59 >/= 60
Jet area / LA (%) < 20 % > 40 %

Tricuspid valve
1. Tricuspid stenosis

Causes
● Rheumatic heart disease (thickened valve leaflets)
● Carcinoid syndrome (normal valve leaflets)
● Valve thickening and calcification
● Obstruction due to thrombus or tumor

Evaluation
Parameter Normal Severe
Mean pressure drop (mmHg) >/ = 5
Valve area (cm2) > 7.0 < 1.0

2. Tricuspid regurgitation
Causes

Right heart pathology
● Pulmonary hypertension
● Cor pulmonale
● Ischemic heart disease
● Pacing lead
● Cardiomyopathy
● ASD/VSD – causes RV volume
overload

Valvular pathology
● Infective endocarditis
● Rheumatic heart disease
● Mitral stenosis – causing pulmonary
hypertension
● Ebstein anomaly
● Carcinoid syndrome
● Pathology of subvalvular apparatus
o Rupture of chordate tendinae
o Papillary muscle dysfunction
● Connective tissue disease / Rheumatoid
arthritis

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Evaluation
Parameter Mild Moderate Severe
Jet area < 5 5 - 10 > 10
PISA radius (cm) < 0.5 0.6 - 0.9 > 0.9
RA/RV/IVC Normal Normal/dilated Dilated
CW jet Soft, parabolic Dense, triangular
Hepatic vein flow Predominantly systolic Reversed in systole

Pulmonary valve
1. Pulmonary stenosis
Causes
● Part of congenital syndromes
○ Noonan’s syndrome
○ Tetralogy of Fallot
○ Rubella
● Acquired
○ Rheumatic fever
○ Carcinoid syndrome
● Subvalvular pulmonary stenosis may be associated with
○ Ventricular septal defect
○ Tetralogy of Fallot
○ Transposition of great arteries

Evaluation
Mild Moderate Severe
Valve area (cm2) >1 0.5 - 1 < 0.5
Peak gradient (mmHg) < 36 36 - 64 > 64
Peak velocity (m/s) <3 3 - 4 > 4

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2. Pulmonary regurgitation
Causes
● Carcinoid syndrome (with tricuspid valve disease)
● Endocarditis
● Congenital valve abnormalities
● Pulmonary valve prolapse

Evaluation
Parameter Mild Mod Severe
Jet size (cm) Narrow Wide and large
Regurgitant fraction (%) < 40 40 - 60 > 60
RVOT vti / LVOT vti Raised Significantly elevated

Right atrial pressure
0 -5 mmHg 5-10 mmHg 10-15 mmHg 15-20 mmHg > 20 mmHg
IVC
Size (cm) < 1.5 1.5 - 2.5 1.5 - 2.5 > 2.5 > 2.5
Variation with
respiration
Collapses
fully
> 50%
collapse
< 50%
collapse
< 50% collapse No collapse
RA size Normal Normal Mildly dilated Moderately
dilated
Severely
dilated
Hepatic vein Mildly dilated Severely
dilated

OR
Diameter of IVC on expiration
(cm)
IVC collapse on inspiration
(%)
Estimated Right Atrial pressure
(mmHg)
< 2 Full collapse 0 - 5
< 2 > 50 5 - 10
> 2 25 - 50 10 - 15
> 2 < 25 15 - 20