echo findings of severe aortic stenosis

Valvular findings of aortic stenosis includes increased peak velocity, increased mean and peak gradient gradient, and decreased aortic valvular area:

It's important to note that there are two situations in which you can have gradient less than 40mmHg and still have severe aortic stenosis:

  • in HFrEF patients, there's not enough cardiac output to to create the high gradient
  • in patients with LVH, there's not enough volume of blood being pushed in systole to create high gradient

These are called low flow, low gradient states. To avoid missing severity of AS in these patients, use dimensionless index:

Dimensionless index=LVOT VTIAV VTIDimensionless\space index = \frac{LVOT\space VTI}{AV\space VTI}

As AS severity increases, the flow across AV is much quicker compared to LVOT. DI < 0.25 is severe AS.

1

Footnotes

  1. https://emcrit.org/emcrit/critical-aortic-stenosis/ ↩