Aortic stenosis echocardiography: Difference between revisions
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{{Template:Aortic stenosis}} | {{Template:Aortic stenosis}} | ||
{{CMG}}; '''Associate | |||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu], [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu], [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org] | |||
==Overview== | ==Overview== | ||
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==Echocardiogram== | ==Echocardiogram== | ||
[[Echocardiogram]] | *[[Echocardiogram]] is the best non-invasive test to evaluate the aortic valve anatomy and function. | ||
*The aortic valve area can be [[Aortic valve area calculation|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: <blockquote>Gradient = 4(velocity)² mmHg</blockquote> A normal aortic valve has no gradient, and a normal aortic valve area is >2 cm<sup>2</sup>. | |||
*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 cm<sup>2</sup>. | If the mean pressure gradient across the valve is <25 mm Hg, or the valve surface area is between 1.3 and 2.0 cm<sup>2</sup>. | ||
====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 cm<sup>2</sup>. | 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 cm<sup>2</sup>. | ||
====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 cm<sup>2</sup>. If the valve area is between 0.7 and 1.0 cm<sup>2</sup>, the stenosis is moderate-severe. | If the mean pressure gradient across the valve is >50 mm Hg, or the valve surface area is less than 0.7 cm<sup>2</sup>. If the valve area is between 0.7 and 1.0 cm<sup>2</sup>, 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]]). | *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]]). | ||
==ACC/AHA Guidelines- Echocardiography (Imaging, Spectral, and Color Doppler) in Aortic Stenosis | ==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>== | ||
{{cquote| | {{cquote| | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ||
'''1.''' Echocardiography is recommended for the diagnosis and assessment of | '''1.''' Echocardiography is recommended for the diagnosis and assessment of [[aortic stenosis]] severity. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
'''2.''' Echocardiography is recommended in patients with [[aortic stenosis]] for the assessment of left ventricular wall thickness, size, and function. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
'''3.''' Echocardiography is recommended for re-evaluation of patients with known [[aortic stenosis]] and changing symptoms or signs. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}} | ||
==Examples== | |||
=====Demonstration of Diastolic Mitral Regurgitation due to Severe Aortic Stenosis===== | |||
[[Image:Diastolic_MR_Due_to_AS.jpg|thumb|350px|left|Diastolic mitral regurgitation due to severe aortic stenosis]] | |||
<br clear="left"/> | |||
=====Demonstration of Aortic regurgitation combined with Aortic Stenosis===== | |||
{{#ev:youtube|J-Qs_evodww}} | |||
== | =====Demonstration of Calcific Aortic Stenosis with Mitral Annular Calcification and Moderate Mitral Regurgitation===== | ||
{{#ev:youtube|qjpV19034sk}} | |||
==References== | ==References== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Congenital heart disease]] | [[Category:Congenital heart disease]] | ||
[[Category:Cardiac surgery]] | [[Category:Cardiac surgery]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Revision as of 17:54, 9 April 2012
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis echocardiography On the Web |
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American Roentgen Ray Society Images of Aortic stenosis echocardiography |
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Directions to Hospitals Treating Aortic stenosis echocardiography |
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Risk calculators and risk factors for Aortic stenosis echocardiography |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Mohammed A. Sbeih, M.D. [5]
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.
- 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:
A normal aortic valve has no gradient, and a normal aortic valve area is >2 cm2.Gradient = 4(velocity)² mmHg
- 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).
ACC/AHA Guidelines- Echocardiography (Imaging, Spectral, and Color Doppler) in Aortic Stenosis [1]
| “ |
Class I1. 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) |
” |
Examples
Demonstration of Diastolic Mitral Regurgitation due to Severe Aortic Stenosis
Demonstration of Aortic regurgitation combined with Aortic Stenosis
{{#ev:youtube|J-Qs_evodww}}
Demonstration of Calcific Aortic Stenosis with Mitral Annular Calcification and Moderate Mitral Regurgitation
{{#ev:youtube|qjpV19034sk}}
References
- ↑ 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.