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]

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. If the mean gradient is <25 mm Hg, the stenosis is mild; if the mean gradient is between 25 mm Hg and 50 mm Hg, the stenosis is moderate; if the mean gradient is >50 mm Hg the stenosis is severe; and when the gradient is greater than 70 mm Hg, the stenosis is critical. A normal aortic valve area is >2 cm². If the valve area is between 1.3 and 2.0 cm², the stenosis is mild; if the valve area is between 1.0 and 1.3 cm², the stenosis is moderate; if the valve area is between 0.7 and 1.0 cm², the stenosis is moderate-severe; areas of less than 0.7 cm² constitute severe aortic stenosis.

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)

Diastolic mitral regurgitation due to severe aortic stenosis

Calcific Aortic Stenosis

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Severity summary

Severity of aortic stenosis

Severity	mild	moderate	severe
Valve area	2.0 - 1.5	1- 1.5	<1
peak velocity (m/s)	2 -3	3-4	>4
Peak gradient (mmHg)	<35	35-65	>65
Mean gradient (mmHg)	<20	20-40	>40