- Some kind of problem with the aortic valve repair, such as new aortic regurgitation (AR) should be a concern. The patient has no reports of fever, but endocarditis should always be considered in a post-operative valve repair. The widened pulse pressure was also noticed by the physician, which could indicate aortic regurgitation.
- As with any post-operative patient, pulmonary embolism should be on the list. This patient’s Wells Score is at least 3 (post-operative +1.5, HR over 100 +1.5), and could be as high as 6 if you think PE is the most likely diagnosis. The physician thought the presence of the loud murmur made PE less likely.
- Pericardial effusion and impending tamponade is a possibility if there has been slow postoperative bleeding into the pericardial sac.
- CHF is less likely given the clear lungs and absent PND/orthopnea.
|Parasternal Short Axis View at the level of the aortic valve|
|Apical 4 Chamber View|
After reviewing the images, take a second to consider your differential diagnosis now. As always, we ask ourselves the following questions after performing the cardiac ultrasound:
What qualifies as significant aortic regurgitation (AR)?
- Even without a detailed knowledge of valvular assessment, qualitative assessment of LV and RV function is still useful in narrowing the differential diagnosis in a patient with suspected valve dysfunction.
- Hemodynamically significant aortic regurgitation will usually have a jet that fills >65% of the LVOT.
- Aliasing is an important artifact to recognize when using colour doppler and may require you to increase the scale on the machine.