Chapter 6. Valvular heart disease & Strain — Volume vs pressure problem

Chapter 6. Valvular heart disease & Strain — Volume vs pressure problem

Valvular heart disease

Carabello BA. Braunwald’s Heart Disease, 9th ed. Pg 64

Pressure problem

  • Critical AS with still normal ventricular dimensions and concentric LVH (myocardial mass 143g/m2, RWT 0,43)

  • Often basal and septal reduction more than you would expect with the existing degree of LVH

Critical AS and concentric LVH

Critical AS and concentric LVH

Volume problem

  • Bicuspid AV with prolapse of the RCC and severe eccentric AR & eccentric LVH ➜ volume overload

Severe AR (TEE & TTE) with severe LV dilatation

Severe AR (TEE & TTE) with severe LV dilatation

Hypertrophy

  • EF is preserved for a long time, GLS decreases (reduced GLS for the same EF) ➜ hypertrophied chamber, small LV

Dilatation

  • GLS & EF will be reduced faster compared to hypertrophy

Concentric & eccentric LVH vs Terminal disease

Normal

Normal

Critical AS & LVH, moderately reduced LV-Strain

Critical AS & LVH, moderately reduced LV-Strain

Dilated LV with borderline LV-Strain in AR

Dilated LV with borderline LV-Strain in AR

End-stage AS with severely reduced LV-Strain

End-stage AS with severely reduced LV-Strain

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The contents of the website, including the videos, were created without influence from third parties.

The Strain Book

Represented by Dr. Martin Altersberger

Contact: heart.lungs.ultrasound@gmail.com

The Strain Book

Represented by Dr. Martin Altersberger

Contact: heart.lungs.ultrasound@gmail.com

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.