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The correct answer is D, pulmonic valve, pulmonic stenosis and pulmonic regurgitation. The spectral Doppler profile demonstrates high velocity flow away from the probe in systole and lower velocity flow towards the probe in diastole. The systolic flow is not holosystolic but rather is a later peaking ejection jet, suggestive of aortic stenosis or pulmonic stenosis. Thus choices A, C and E are incorrect as a regurgitant atrioventricular valve typically has a holosystolic jet on spectral Doppler and does not peak in mid or late systole. We are then left to differentiate between aortic stenosis/regurgitation and pulmonic stenosis/regurgitation. The key here lies in the diastolic flow. The 3.5 m/s jet in systole could signify moderate aortic stenosis or severe pulmonic stenosis. However, the velocity at end diastole is only 1.5 m/s equating to a pressure gradient of 9 mm Hg between the PA/RV or AO/LV at end diastole. Unless there is severe AI, this gradient is too low to be between the aorta and LV, otherwise aortic diastolic pressure would be similar to LVEDP which is unlikely. Thus, the correct answer is pulmonic stenosis/regurgitation.


Valve disease

Author: Atif Qasim, MD FASE
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