Aortic stenosis echocardiography

Aortic Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4]

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 (heart ultrasound) is the best non-invasive test to evaluate the aortic valve anatomy and function.

The aortic valve area can be calculated non-invasively using echocardiographic flow velocities. Using the velocity of the blood through the valve, the pressure gradient across can be calculated by the equation:

Gradient = 4(velocity)² mmHg

A normal aortic valve has no gradient, and a normal aortic valve area is >2 cm². Aortic stenosis severity can be divided according to the pressure gradient across the valve and the surface area of the valve.

Mild Aortic Stenosis: If the mean pressure gradient across the valve is <25 mm Hg, or the valve surface area is between 1.3 and 2.0 cm².

Moderate Aortic Stenosis: If the mean pressure gradient across the valve is between 25 mm Hg and 50 mm Hg, or the valve surface area is between 1.0 and 1.3 cm².

Severe Aortic Stenosis: If the mean pressure gradient across the valve is >50 mm Hg, or the valve surface area is less than 0.7 cm². If the valve area is between 0.7 and 1.0 cm², the stenosis is moderate-severe.

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).