Aortic stenosis echocardiography: Difference between revisions

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*Valve surface area is less than 0.7 cm<sup>2</sup>, or
*Valve surface area is less than 0.7 cm<sup>2</sup>, or
*Jet velocity is greater than 4.0 m per second
*Jet velocity is greater than 4.0 m per second
{| border = 1
|+ ''Severity of Aortic Stenosis''
! |Severity|| mild||moderate || severe
|-
| Valve area  || 2.5 - 1.5 || 1.5 - 1.0 || <1.0
|-
| peak velocity (m/s) || 2 - 3 || 3 - 4 || >4
|-
| Peak gradient (mmHg)|| <25 || 25 - 40 || >40
|-
| Mean gradient (mmHg) || <20 || 20-40  || >40
|}


==ACC/AHA Guidelines- Echocardiography (Imaging, Spectral, and Color Doppler) in Aortic Stenosis <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>==
==ACC/AHA Guidelines- Echocardiography (Imaging, Spectral, and Color Doppler) in Aortic Stenosis <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>==

Revision as of 00:08, 10 April 2012

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

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Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

Aortic stenosis echocardiography On the Web

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Risk calculators and risk factors for Aortic stenosis echocardiography

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mohammed A. Sbeih, M.D. [2]

Overview

Echocardiography may be used as a diagnostic tool in the evaluation of aortic stenosis. As an evaluative tool, echocardiograms can identify functionality issues within the heart's anatomy. An aortic stenosis patient will present symptomatic evidence of a pressure gradient, the result of left ventricular hypertrophy.

Echocardiogram

Echocardiogram is the best non-invasive test to evaluate the aortic valve anatomy and function.

2D Echocardiography of the aortic valve in the parasternal long axis view demonstrates right and non coronary leaflets. In the parasternal short axis view, leaflets open equally and forms a circular orifice during systole. During diastole, the normal leaflets form a three pointed star with prominence at the closing point (nodules of Arentius).

Severity of Aortic Stenosis

Aortic stenosis severity can be assessed by estimating both the pressure gradient across the valve and the surface area of the valve.

  • Using the velocity of the blood through the valve, the pressure gradient across the valve can be calculated by the equation:

    Gradient = 4(velocity)² mmHg

Normal Aortic Valve:

  • A normal aortic valve has no gradient, and
  • Aortic valve surface area is of 2.5 to 3.5 cms2.

Mild Aortic Stenosis:

  • Mean pressure gradient across the valve is less than 25 mm Hg, or
  • Valve surface area is between 1.5 and 2.5 cms2, or
  • Jet velocity less than 3.0 m per second

Moderate Aortic Stenosis:

  • Mean pressure gradient across the valve is between 25 mm Hg and 40 mm Hg, or
  • Valve surface area is between 1.0 and 1.5 cms2, or
  • Jet velocity 3.0 to 4.0 m per second

Moderate to Severe Aortic Stenosis

  • Valve surface area is between 0.7 and 1.0 cms2

Severe Aortic Stenosis:

  • Mean pressure gradient across the valve is more than 40 mm Hg, or
  • Valve surface area is less than 0.7 cm2, or
  • Jet velocity is greater than 4.0 m per second
Severity of Aortic Stenosis
Severity mild moderate severe
Valve area 2.5 - 1.5 1.5 - 1.0 <1.0
peak velocity (m/s) 2 - 3 3 - 4 >4
Peak gradient (mmHg) <25 25 - 40 >40
Mean gradient (mmHg) <20 20-40 >40

ACC/AHA Guidelines- Echocardiography (Imaging, Spectral, and Color Doppler) in Aortic Stenosis [1]

Class I

1. Echocardiography is recommended for the diagnosis and assessment of aortic stenosis severity. (Level of Evidence: B)

2. Echocardiography is recommended in patients with aortic stenosis for the assessment of left ventricular wall thickness, size, and function. (Level of Evidence: B)

3. Echocardiography is recommended for re-evaluation of patients with known aortic stenosis and changing symptoms or signs. (Level of Evidence: B)

4. Echocardiography is recommended for the assessment of changes in hemodynamic severity and left ventricular function in patients with known aortic stenosis during pregnancy. (Level of Evidence: B)

5. Transthoracic echocardiography is recommended for re-evaluation of asymptomatic patients: every year for severe aortic stenosis; every 1 to 2 years for moderate aortic stenosis; and every 3 to 5 years for mild aortic stenosis. (Level of Evidence: B)

Class IIa

1. Dobutamine stress echocardiography is reasonable to evaluate patients with low-flow/low-gradient aortic stenosis and left ventricular dysfunction. (Level of Evidence: B)

Examples

Demonstration of Diastolic Mitral Regurgitation due to Severe Aortic Stenosis
Diastolic mitral regurgitation due to severe aortic stenosis


Demonstration of Aortic regurgitation combined with Aortic Stenosis

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Demonstration of Calcific Aortic Stenosis with Mitral Annular Calcification and Moderate Mitral Regurgitation

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References

  1. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.

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