Pulmonary Valve Area by Velocity Ratio

How to get a Pulmonary Valve Area by Velocity Ratio.

1. Measure the LVOT diameter in centimeters. The optimal view is a maximally zoomed view of the upper esophageal ArchSAX/PVLAX or the RVIO view. The gain and compress should be set so the endomyocardial wall of the RVOT is clearly discernable. Freeze the display and use the trackball to cycle thru the cardiac cycle to the mid-ejection period when the RVOT is at it's maximal diameter. Using the calipers, measure from intimal wall to intimal wall just proximal to the aortic valve. Enter the RVOT diameter above.
2. Obtain a continuous wave doppler of the pulmonic valve. The optimal view is the deep transgastric PVLAX view or the upper esophageal ArchSAX/PVLAX view. The latter view is preferable if obtainable. Once the view is obtained turn on the CWD and use the track ball to move the CWD line to the pulmonic valve. A doppler profile of the aortic valve should be displayed with high velocities in pulmonic stenosis. If a poor or low velocity doppler wave form is displayed reposition the view and move the CWD line thru out the valve. The CWD must be parallel to the stenotic jet to pick up the maximal velocity and obtain a good doppler wave form. After a good doppler wave form is obtained look at the morphology of the waveform and note it. Using the tracing feature, use the trackball and trace the doppler profile. The maximum velocity, Vmax, for the AV should be enter above.
3. Obtain a pulse wave doppler of the RVOT. The optimal view is the deep transgastric PVLAX view or the upper esophageal ArchSAX/PVLAX view. The latter view is preferable if obtainable. Once the view is obtained turn on the PWD and use the track ball to move the PWD line to the RVOT and place the sample volume just proximal to the pulmonic valve. The sample volume should be at the same location where the RVOT diameter was measured. A doppler profile of the RVOT should be displayed with normal velocities in the RVOT. If a poor or low velocity doppler wave form is displayed reposition the view and move the PWD line thru out the RVOT. The PWD must be parallel to the RVOT jet to pick up the maximal velocity and obtain a good doppler wave form. After a good doppler wave form is obtained look at the morphology and the maximal velocity of the waveform and note it. Using the tracing feature, use the trackball and trace the doppler profile. The maximum velocity, Vmax, for the LVOT should be entered above.