Echo-of-the-Day

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Echo-of-the-Day Information

The Echo-of-the-Day is a presentation of 1 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.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
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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

Echo of the Day Information Table

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

Aortic Regurgitation

Case#: 91

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

Presentation:
A patient presents aortic regurgitation murmur. The following echo loops where imaged from the patient.

Loop(s):

Case Discussion

The echocardiographic findings are ascending aortic aneurysm, sinotubular junction effacement, severe aortic regurgitation, sidel lobe artifact in the ascending aorta probably from a PAC, normal aortic valve apparatus except for the dilated and effaced sinotubular junction (STJ).

The diagnosis is severe aortic regurgitation from an ascending aortic aneurysm that disrupted the sinotubular junction:aortic valve annulus ratio. The cause of the aortic aneurysm is most likely due to a connective tissue disease (Marfan's Syndrome, Ehlers-Danlos syndrome, idiopathic cystic medial degenreation) because of the STJ effacement. Other causes of ascending aortic aneurysms (hypertension, BAV) do not usually cause effacement of the sinotubular junction/Sinuses of Valsalva.

The aortic regurgitation is severe. The jet is wide and exceeds 66% of the LVOT diameter. Since the aortic valve is relatively normal, replacing the ascending aorta (modified Bentall/David procedure) should be able to correct the aortic regurgitation.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Valve Sparing Aortic Root Replacement with Aortic Valve Re-Implantation
Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade?
Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting.