Assessing heart valve disease with handheld ECHO

4th Dec 2020

Although valve disease has not been associated with COVID-19, handheld echocardiography (HHE) devices can identify important valve pathologies that may influence subsequent patient management. 

An overview of the heart valve anatomy can be performed with HHE and should describe three characteristics (if the image quality allows):

  1. Leaflet motion
  2. Degree of calcification
  3. Degree of regurgitation  

 

Describing leaflet motion in patients with COVID-19

Leaflet (e.g., cusp) motion should be assessed and categorized as normal, prolapsing, or restricted. The motion of the aortic and mitral valve leaflets can be seen in the parasternal long-axis (PLAX) view. 

Echocardiogram from the parasternal long-axis (PLAX) view with labels on the aortic and mitral valves.

Figure 1. The motion of the aortic and mitral valve leaflets can be seen in the parasternal long-axis (PLAX) view. Leaflet (e.g., cusp) motion should be assessed and categorized as normal, prolapsing, or restricted.

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights the normal motion of the aortic and mitral valves in the PLAX view:

 

 

Describing the degree of calcification in patients with COVID-19

The degree of calcification of the valve structures should be assessed with HHE and described as mild, moderate, or severe. HHE devices mainly allow for qualitative visual assessment of calcification. 

The parasternal short-axis (PSAX) and apical three-chamber views can show calcification and restricted motion of the aortic valves, which indicates aortic stenosis. 

Echo images showing calcification. Parasternal short-axis (PSAX) and apical-three chamber views. 

Figure 2. Parasternal short-axis (PSAX) and apical three-chamber views showing calcification of the aortic valve, which indicates aortic stenosis. 

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights the restricted aortic valve motion due to calcification, which indicates aortic stenosis:

 

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Describing the degree of regurgitation in patients with COVID-19

The degree of regurgitation should be assessed using the device’s color flow Doppler and classified as mild, moderate, or severe. Keep in mind, it can be challenging to assess regurgitation with the color flow Doppler, particularly with eccentric jets! 

Color flow Doppler echocardiogram showing eccentric jet in mitral valve regurgitation.

Figure 3. Regurgitation of the mitral valve using color flow Doppler. In this case, it can be challenging to assess and classify the degree of regurgitation due to the eccentric jet.

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights mitral valve regurgitation using color flow Doppler:

 

It should be noted that assessment using HHE provides a gross overview of a valve lesion. A suspected valve lesion should trigger a formal transthoracic echocardiogram for a complete physiological assessment at an appropriate time in the patient’s pathway.

For more information on how to perform an in-depth assessment of the aortic valves, see Medmastery’s Echo Masterclass: The Valves.  

Aortic dissection an important differential diagnosis for patients presenting with chest pain. Handheld echocardiography HHE can play a significant role in rapidly aiding clinical assessment. Timely diagnosis of this condition is pertinent in the COVID er

 

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Recommended reading

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