Case Study

Aortic Stenosis

Patient: An 82 year old female patient presented to the ER with symptoms and signs of congestive heart failure.

Initial Examination: She had a history of well controlled hypertension treated with beta blockers and diuretics by her primary care physician. On cardiac auscultation a mid-systolic ejection murmur was noted with diminished S2 heart sound. Her jugular veins were dilated and mild lower limb edema was present.

Kosmos POCUS Examination: Bedside examination with KOSMOS revealed severely impaired left ventricular systolic function. The aortic valve was heavily calcified and had severe stenosis. Moderate functional mitral regurgitation was also present. Patient was treated with intravenous diuresis resulting in improvement of her symptoms. A subsequent coronary angiogram revealed no coronary stenoses. She was scheduled for a TAVI procedure.

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Video 1

PLAX view showing dilated left ventricle with severely impaired overall systolic function. Diffuse hypokinesis of LV walls is seen. The aortic valve is heavily calcified and not opening well. There is symmetric tethering of both mitral valve leaflets due to LV remodeling. There is also mild pericardial effusion.

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Video 2

PLAX view with color showing moderate functional mitral regurgitation.

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Video 3

PLAX view with color on the aortic valve showing aortic stenosis and mild aortic regurgitation.

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Video 4

PSAX view at the level of the papillary muscles showing severely impaired LV systolic function.

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Video 5

PSAX view at the level of the aortic valve showing a heavily calcified tricuspid with stenotic behavior.

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Video 6

PSAX view at the level of the aortic valve with color showing mild aortic valve regurgitation.

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Video 7

A4C view showing dilated LV with severely impaired systolic function. The RV has normal size and systolic function. There is also bi-atrial enlargement. A small pericardial effusion is evident.

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Video 8

A2C view showing dilated LV with severely impaired systolic function.

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Video 9

A3C view showing dilated LV with severely impaired systolic function. The aortic valve is severely calcified.

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Figure 1

Automated EF calculation with KOSMOS AI confirming the visual impression of severely impaired LV systolic function.

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Video 10

A4C view with color showing moderate functional mitral regurgitation.

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Video 11

CW MR signal from apical four chamber view.

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Video 12

A5C view with color showing turbulent flow through the stenosed AV.

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Video 13

CW AS signal from A5C view.

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Figure 2

Maximum aortic valve velocity measured at 3,7-3,8 m/s with CW.

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Video 14

CW AR signal from A5C view.

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Video 15

PW LVOT signal showing reduced forward LV stroke volume.

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Figure 3

Maximum LVOT velocity measured at 0.54 m/s with PW, suggestive of low flow state.

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Video 16

A4C view with color showing mild functional tricuspid regurgitation. There is also color flow inside the RA coming from the IAS, suggestive of a patent PFO with left to right shunt due to increased LA pressure.

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Video 17

Subcostal view showing dilated IVC.

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