Rheumatism (often associated with mitral valve insufficiency. Infective endocarditis. Congenital valve insufficiency (can be combined with valve stenosis). Relative aortic insufficiency (syphilitic aortitis, dissecting aortic aneurysm, ankylosing spondylitis, Marfan disease, aorto-arteritis, etc.)
As with mitral insufficiency, structural changes in the heart with this defect are due to volume overload syndrome (primarily of the left ventricle). In M-mode, one can detect: 1. fibrosis (calcification) of AK valves (more often with rheumatic or atherosclerotic lesions) with their separation into diastole, 2. small-amplitude diastolic flutter of the anterior cusp of MK (under the action of reverse blood flow from the aorta), 3. dilatation LV cavity.
B-mode: 1. LV from ellipsoid becomes more spherical in shape with dilatation of its cavity in severe cases (DAC exceeds 7 cm), 2. hypertrophy and hyperkinesis of the LV walls. DehoKG has the greatest information content in diagnosing this defect and determining its severity, especially color scanning. The regurgitation flow in the apical or parasternal position looks like a signal of different color (due to turbulence), starting from the aortic valve and penetrating into the LV cavity. Several methods of indirectly assessing the severity of regurgitation AO have been proposed: 1. the length of the regurgitation jet (1st order – up to 2 cm, 2nd stage – 2-4cm, 3rd stage – 4-6cm, 4th stage – more than 6cm), 2. the area of the regurgitation jet according to short axis (1st. – up to 0.2cm 2 , 2nd . – 0.2 – 0.6cm 2 , 3rd. – 0.6 – 1.2cm 2 4st. –More than 1.2 cm 2 ), 3. the area of the jet of regurgitation from the apical position (1st .- up to 1.5 cm 2 , 2nd . – 1.5-4 cm 2 , 3rd. – 4 – 8 cm 2 , and 4 tbsp. – more than 8 cm 2 ), 4. maximum speed aortic regurgitation in the mode of continuous-wave doppler (a speed of more than 3 m / s indicates how severe aortic insufficiency was ruled. 5. both of the regurgitation fraction (FF volume more than 50% of the stroke volume also characterizes severe aortic insufficiency).
It must be emphasized that none of these signs is absolute in assessing the severity of the defect. It can be judged as a whole only by the totality of all indicators as a whole.
signs of LV volume overload small-amplitude “shake” of the anterior cusp of the MK in early diastole
The regurgitation flow on the AK The regurgitation flow on the AK from the parasternal position
The regurgitation flow on the AK in the color doppler mode from the apical access Figure 2.4 EchoCG with aortic insufficiency.
Modes B and M: 1. the presence of moving on a narrow or wide base of echoes of different density (depending on the duration of the process) on the valves (chords), 2. the presence of characteristic signs for mitral or aortic regurgitation, 3. signs of pericarditis are often detected, 4. possible decrease in the LV pumping function.
Doppler mode – signs of regurgitation on the MC or AK. It should be emphasized that in 15 – 20% of cases, endocarditis on the valves is non-infectious in nature (Lupus endocarditis Libman-Sachs, tumors of various organs, conditions associated with antiphospholipid syndrome, etc.). In these cases, as a rule, no pronounced regurgitation is observed, since the valve collapses slightly. It is rather difficult to identify vegetations on modified valves (with existing defects, as well as in the case of prosthetic valves).