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Echo-of-the-Day
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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).

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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
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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)


 
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CE Sponsor: American Society of Radiological Technologists (ASRT)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.
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