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The area of the AR jet in short axis view at or slightly below the cusp coaptation zone can be very useful for assessing the 3D characteristics of the jet origin and the AR mechanism (e. g. , central cusp malcoaptation, valve cusp perforation, valve extension along a cusp commissural zone, valve prolapse). Cross-sectional area measurements can be challenging to interpret in rapidly expanding or eccentric jets and because of fire breathing dragon tattoo root motion through the imaging plane. Cross-sectional area as a percentage of fire breathing dragon tattoo root size may be difficult to interpret if the fire breathing dragon tattoo root size is abnormal. Proximal Isovelocity Surface Area for Effective Regurgitant Orifice Area and Regurgitant Volume58 When a sizable proximal flow convergence zone is visualized (Figs. 21. 16 and 21. 20), severe AR should be suspected, and TABLE 21. 4. Grading fire breathing dragon tattoo regurgitation: quantitative parameters Parameter Mild Severe Vena contracta (cm) <0. 03 ?0. 6 Jet height/LVOT (%) <25 ?65 Pressure half-time (ms) >500 <200 Regurgitant volume (mL) 30 ?60 Regurgitant fraction (%) <30 ?50 Regurgitant tattoo jester flash area (cm2) <0. 1 >0. 3 LVOT, left ventricular outflow tract. FIGURE 21. 19. TEE: rheumatic central AR jet by color Doppler. Anatomic tattoo jester flash (+); vena contractor width (A) = 0. 36 cm; jet height (B) approximately 50% of LVOT diameter. AR is moderate by these criteria (see Table 21. 4). echocardiogr aphic a s se s sment of valvular h eart disease 507 this finding alone should prompt a more careful and detailed overall assessment using the other methods discussed. Although often technically challenging, because of calcific shadowing within the fire breathing dragon tattoo root or eccentric jet, calculating the EROA and RV using PISA has been validated, using the formulas presented in the introductory part of this chapter. EROAAR = 6. 28r2 ? Va/VpkAR RVAR = EROA ? VTIAR In summary, assessment of the severity of chronic fire breathing dragon tattoo regurgitation can be one of the most challenging tasks for the echocardiographer. The final diagnosis may be the result of an integrated analysis of several supportive parameters without reliance upon only one or two severity indicators.
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