Pathophysiology
Anatomy
Aetiology & Mechanisms
Approach to Assessment
Overview of Approach
How should aortic stenosis (AS) be assessed using echo?
- Valve morphology assessment
- Colour flow doppler trace assessment
- Continuous wave doppler trace assessment
- Pulsed wave doppler trace assessment
- Valve morphology
- Colour flow MR jet size / LA (%)
- Vena Contracta size (mm)
- Flow convergence zone / PISA (mm)
- Dominant mitral inflow wave
- Pulmonary vein systolic flow
- MV inflow VTI/LVOT VTI
- Continuous wave signal of MR jet
- EROA - Regurgitant orifice area (cm²)
- R vol - Regurgitant volume (mL)
- Regurgitant fraction (%)
- LA dilatation
- LV dilatation
- Valve morphology
- Overall assessment of severity
- Integration with symptoms and clinical features
Morphology, Aetiology & Mechanisms
Continuous Wave Doppler Signal
Colour Flow Doppler Signal
Secondary Consequences
Grading of Severity
Overview of Severity Grading
Which echo features are used to grade aortic Stenosis severity?
- No single measure should be used to grade the severity of mitral stenosis – agreement between measures increases reliability of grading
- Grading mitral stenosis severity requires a combination of parameters:
- Mean pressure gradient
- Pressure half-time (CW Doppler)
- MVA from planimetry
- MVA from continuity equation
- PISA methods
- Systolic pulmonary artery pressure
Which values are used to grade the severity of mitral stenosis?
Mean Gradient
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Which values of mean gradient are used to grade severity of mitral stenosis?
Mild
Moderate
Severe
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Mitral Valve Area (MVA)
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Which values of continuity equation valve area are used to grade severity of mitral stenosis?
Mild
Moderate
Severe
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Pressure Half Time (T1/2)
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Which values of pressure half-time (T1/2) are used to grade severity of mitral stenosis?
Mild
Moderate
Severe
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What are the limitations of using ….. in the assessment of ….?
Systolic Pulmonary Artery Pressure
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Which views are used to assess ….. in ….?
How is ….. measured in the assessment of ….?
Which values of pulmonary artery systolic pressure are used to grade severity of mitral stenosis?
Mild
Moderate
Severe
What are the advantages of using ….. in the assessment of ….?
What are the limitations of using ….. in the assessment of ….?