Echo-of-the-Day

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Echo-of-the-Day Information

The Case-of-the-Week is a presentation of 8 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= Windows Media Video	= MP4 Video
= QuickTime	= WebM Video
= Flash	= Ogg Video
= JPG Image	= GIF Image
Image/Video Sizes
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE
	= Legacy/Old Video Formats

Case of the Month Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Aortic Root Size and Ratio

Case#: 146

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.

Presentation:
A patient presented with the following loops:

Loop(s):

Case Discussion

The normal size of an ascending aorta depends upon the size and age of the patient. The following formulas have been used to calculate normal ascending aorta diameter:

< 20 yrs old	SOVd = 1.02 + 0.98 x BSA
20-39 yrs old	SOVd = 0.97 + 1.12 x BSA
> 40 yrs old	SOVd = 1.92 + 0.74 x BSA

This patient had a normal ascending aorta diameter. The relationship of the LVOT:SOV:STJ:AscAo can indicate the presence of aortic dilation (ie. Marfans) and can be used as a screening test. If the AVA;SOV diameter is less than 1.45 then aortic dilation is not present in patients up to 15 years old. Also, the ratios give an indication to the mechanism of AR if AR is present.

The aortic valve is a component of the aortic root . The aortic valve can be affected by, and in turn, affect the aortic root. The aortic root consists of the aortic valve (aortic valve cusps and aortic valve annulus), the Sinuses of Valsalva, the sinotubular junction (junction of the sinus of valsalva and ascending aorta), and the ascending aorta. The aortic root's narrowest point is the aortic valve annulus, out pouches at the level of the sinuses of valsalva, narrows to the sinotubular junction and enlarges at the level of the ascending aorta . Proximal to the aortic valve is the left ventricular outflow tract (LVOT).

For the aortic valve to function normally, proper orientation and dimensions must be maintained. Normal orientation includes a ratio of LVOT:Sinus of Valsalva Height:Sinotubular Junction Width. Derangement of these ratio's gives an indication of the pathology causing aortic regurgitation.

Structure	Size (range)(cm )
LVOT	2.0 (1.8-2.2 cm)
Aortic Valve Annulus (AVAn)	1.9 (1.4-2.6 cm)
Sinus of Valsalva (SOV)	2.8 (2.1-3.5 cm)
Sinotubular Junction (STJ)	2.4 (1.7-3.4 cm)
Ascending Aorta (Asc Aorta)	2.6 (2.1-3.4cm)

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

A New On-Line Method for Predicting Aortic Root Dilatation during Two-Dimensional Echocardiography in Pediatric Patients with Marfan Syndrome Using the Sinus of Valsalva to Annulus Ratio
Echocardiographic assessment of aortic root dimensions in normal children based on measurement of a new ratio of aortic size independent of growth.
Aortic Root Diameter (Calculator)

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.