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?
- Severity encompasses a continuous spectrum of disease.
- Measures of disease severity therefore need to be viewed in a continuous way – and definition of grades of severity are to some extent arbitrary.
- In clinical practice recommended parameters for grading severity of AS are:
- Maximum Aortic Jet Velocity
- Mean transaortic pressure gradient
- Velocity Ratio
- Aortic valve area (AVA) using continuity equation
- Indexed aortic valve area (AVA) using continuity equation
Which values are used to grade the severity of aortic stenosis?
Peak Velocity
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Which values of peak velocity are used to grade severity of aortic stenosis?
Mild
Moderate
Severe
Very Severe
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Mean Gradient
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Which values of mean gradient are used to grade severity of aortic stenosis?
Mild
Moderate
Severe
Very Severe
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Valve Area (Continuity Equation)
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Which values of continuity equation valve area (unindexed and indexed) are used to grade severity of aortic stenosis?
Mild
Moderate
Severe
Very Severe
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Valve Area (Plannimetry)
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Which values of aortic valve area (AVA) are used to grade the severity of aortic stenosis?
Mild
Moderate
Severe
Very Severe
What are the advantages of using ….. in the assessment of ….?
What are the limitations of using ….. in the assessment of ….?
Velocity Ratio
What are the principles of using ….. in the assessment of ….?
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Which views are used to assess ….. in ….?
How is ….. measured in the assessment of ….?
Which values of velocity ratio are used to grade the severity of aortic stenosis?
Mild
Moderate
Severe
What are the advantages of using ….. in the assessment of ….?
What are the limitations of using ….. in the assessment of ….?