Aortic valve area

	Aortic Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Normal aortic valve offers little or no resistance to the blood flow across the valve despite the high flow velocities. With progressive aortic stenosis, the aortic valve orifice offers progressively greater resistance to the blood flow through the valve with subsequent reduction in the pressure gradient between the left ventricle and the aorta. Therefore, using both the pressure gradient across the valve and the surface area of the valve the severity of aortic stenosis can be estimated. The latter can be calculated using echocardiographic flow velocities while the trans-valvular pressure gradient can be calculated using the following equation:

Pressure Gradient = 4 x (velocity of blood through the valve)² mmHg

However, the absence of a large gradient across the aortic valve does not exclude the presence of critical aortic stenosis as evidenced by the presence of low gradient, low ejection and subsequent low flow aortic stenosis that is associated with poor clinical outcomes. Therefore, it is for this reason that the best measure of the severity of aortic stenosis is the aortic valve area and not the aortic valve gradient.

Cardiac Catheterization

Simultaneous measurement of left ventricular output (measures the flow through the aortic valve) and the pressure gradient across the aortic valve provides the essential variables that is required to calculate the aortic valve area and resistance.^[1]^[2]

According to the current recommendations, following dobutamine infusion, if the aortic valve area increases to >1.2 cm², and the mean pressure gradient rises above 30 mmHg, such patients may benefit from aortic valve replacement. Failure to achieve these improvements has shown to be associated with higher early surgical mortality in comparison to patients who can augment their contractility and gradient: 32-33% versus 5-7%, respectively. Additionally, 5-year survival was lower in patients who could not augment their contractility in comparison to those who could: 10–25% versus 88%, respectively.