Dear Sir, I still cannot understand why we should measure VC in the view that the regurgitant jet is perpendicular to the sound wave. And in terms of tricuspid regurgitation, I found no view that meets this criterion, so is it reasonable to measure VC in the 4-chamber view?
You are right , based on Doppler principle 1) when sound is perpendicular to flow, the Doppler shift will be zero ( no color no velosity) but as I mention in Doppler lecture blood flow at microlevel ( blood sells) are turbulance and for this reason we can detect color in neck of the jet (VC) when sound ilooks is perpendicular to the flow; 2) why measure it in the view that sound is perpendicular to the jet? because in this situation we have more accurate dimension due to lack of other parameters like eddy flow that can overstimate the real VC. check those Doppler lectures . 3) with all of those considerations yes still we can measure VC even it's not perpendicular just make sure your jet orifice is circular ( not oval,) and color optimizing 4) and finally . we evaluate and grade any jet by many parameters ( VC, PISA, jet area, ratio, size of chambers, ....) not one parameter, even soem of them more accurate and sensitive
Dear sir, i have a question, for moderate mitral regurgitation if patient goes to by pass surgery i have read that anteroposterior anulus diameter is very important to decide mitral repair could please explain it i couldnt find more information, thank you
Hi Ebrehenin ! You asked very challenging and sophisticated question; As you know there are many indications & criteria for repairing structural moderate- severe & severe MR & functional severe MR (specially CAD). One of the findings in favor of chronic significant MR is increasing AP diameter ( normal in most references < 24+_1 mm at mid-systole in PLAX). In those cases that patient is going to open heart surgery for other reason like your question CABG, if we have significant regurgitation ( MR , TR, or AR ) we have to evaluate if meanwhile we repair regurgitation or not. In significant chronic MR if AP is high (that indicates it is not due to CAD-functional), we should evaluate other parameters (for repairing technique like tent length & area, circumferential index,..., ....) and repair MR too during surgery.
