Diagnosis of aortic stenosis by echocardiography

1. Aortic Stenosis
Echocardiographic Perspective
Dr. Ayman Noureldin
Professor Of Cardiology-
Mansoura University

2. Echo essentials in AS
• Valve anatomy
• Etiology of AS
• Severity of stenosis

3. Aortic root structure

4. Normal Aortic valve

5. Normal aortic valve M-Mode
• Coaptation in center of aortic root

7. Normal aortic valve

8. Normal aortic valve

9. Normal aortic valve

10. Normal aortic valve

12. Aortic Stenosis- Etiology
• Degenerative Calcific aortic stenosis
• Premature calcific bicuspid aortic valve
• Rheumatic aortic valve disease

14. Calcific aortic stenosis
Progressive reduction in leaflet motion

16. Bicuspid Aortic Valve

17. Bicuspid Aortic Valve
PLAX view- doming

18. Bicuspid Aortic Valve

19. Bicuspid Aortic Valve

20. Bicuspid Aortic Valve

21. Eccentric closure in Bicuspid valve

22. Bicuspid Aortic Valve

23. Bicuspid Aortic Valve

24. Rheumatic Aortic Stenosis
• Commissural fusion
• Thickening
• Less calcification
• Triangular systolic
orifice
• Associated mitral valve
dse

25. Rheumatic Aortic Stenosis

27. Beyond (or before) the valve
Other obstructions to flow

28. Aortic Stenosis Severity

30. Peak Jet Velocity- CW Doppler
• Multiple Acoustic Windows
- Highest velocity- Right parasternal, Suprasternal
• Parallel to Ejection Jet
- Probe Positioning
- No angle correction
• PEDOFF probe preferred

32. Mean Gradient- CW Doppler
• Average gradient during the entire ejection period
- Integration of velocity over time
- Approximately 70% of the Max. instantanous gradient

34. Aortic stenosis CW-Doppler Mitral regurgitation CW-Doppler
Holosystolic
Higher velocity
Mitral inflow

36. Aortic Stenosis
Valve-Area Assessment
Normal valve area = 3-4 cm
Mild stenosis > 1.5 cm
Moderate stenosis 1-1.5 cm
Severe stenosis <1.0 cm
Critical stenosis <0.7 cm

37. Continuity Equation

38. PITFALLS- THE LVOT IS NEVER EASY
??? GO SLIGHTLY OFF AXIS

39. Flow through LVOT
Pulse wave Doppler

40. Flow through LVOT
Pulse wave Doppler

41. Flow across the Aortic valve
Continuous wave Doppler

44. Dimensionless index

47. Report
• AS etiology: (e.g. rheumatic, degenerative, bicuspid)
• AS severity: (Max velocity, mean gradient, AVA)
• AR severity
• Aortic dimensions: Dilatation associated with AVD/bicuspid,
Coarctation
• LVEF, LV hypertrophy
• LA size
• RV size and function: Affects operative risk
• TR Severity
• PAP: Affects operative risk and prognosis
• Other valve disease
• BSA recorded: Index values as appropriate