Echocardiographic

Evaluation of Aortic
Valve

D r . H eb a A b o u z e i d
Basic Echocardiographic evaluation of :

AS
AR

Aortic mechanical valves

Aortic bioprosthesis
 AS

Significant congenital aortic stenosis is uncommon

More in boys
Isolated
Common associations:
BAV, COA, VSD, MV abnormality
Less common associations:
ASD, complete AVSD
 EAE/ASE Aortic stenosis quantitation
recommendations

Data element Recording Measurement

Aortic valve anatomy -Parasternal long- and Identify number of
short-axis views cusps in systole, raphe if
present
Assess cusp mobility and
commisural fusion
Assess valve calcification
AS jet velocity -CW Doppler -Maximum velocity at
-Multiple acoustic peak of dense velocity
windows curve
-Mean gradient

European Association of Echocardiography (EAE).

‡ American Society of Echocardiography (ASE) guidelines 2009.
Anatomic Evaluation of Aortic Valve
Valve anatomy; Bicuspid Aortic valve
Valve anatomy; Bicuspid Aortic valve
 Valve anatomy; Rheumatic AS

Commisural fusion & thickening

MV involvement in rheumatic cases
Level of obstruction; sub-As
 Level of obstruction

Sub-AS (HCM)
AS vs Dynamic LVOTO
PW Doppler of LVOT
Level of obstruction
Level of obstruction
 Level of obstruction

Supra-AS
 Jet velocity

Measured using continuous-

wave (CW) Doppler
Multiple acoustic windows
Adjustment of transducer
position and angle
Correct measurement is flow
dependent
The maximum velocity is
measured at the outer edge of the
dark signal
The outer edge of the dark
‘envelope’ of the velocity curve is
traced
Doppler Intercept Angle
 AS Quantification
Mean and Maximum Gradient
 AS Severity Quantification

Mild AS Moderate AS Severe AS

Jet velocity (m/s) ˂3 3-4 ˃4

Peak ˂ 36 36 - 64 ˃ 64
instantaneous
gradient (mmHg)
Mean gradient ˂ 25 25 - 40 ˃ 40
(mmHg)

Valid only in patients with normal LV function and in absence of other defects

AHA and ACC guidelines 2006 for AS severity estimation based on

Doppler-derived gradients
Pressure gradient measurement by Echo. Vs
Cardiac Catheterization
 Two-dimensional Measurements

Axial / lateral resolution

Early-midsystole/ end diastole
Leading edge to leading edge
Anterior to posterior inner edges
Evaluation of LV function
 Associated signs

Concentric LVH

Post-stenotic
dilatation

Other
valvulopathies

AS as a part of
more complex
lesions
Shone’s complex
Shone’s complex
HLHS
 Potential Source of Error

Doppler alignement
Doppler beam is not aligned with the jet.

Underestimation of stenosis
In patients with low EF

Recording of MR jet

Neglect of an elevated proximal velocity

 Aortic Regurgitation

Congenital or acquired.
Acute or chronic regurgitation

Aortic valve malformation, including bicuspid aortic

valve
Aortic root and annulus dilatation
Associated aortic stenosis.
Echocardiographic findings of severe aortic regurgitation
Echocardiographic findings of moderate aortic regurgitation
 AR Quantification

Visual estimation
The extension of the regurgitant jet in the left ventricle.
Vena Contracta
In parasternal long axis, measure the diameter of the AR
where the jet is the narrowest (through the valve).
AR is considered as severe if the vena contracta diameter is >
6mm and mild if ˂ 3 mm. ( not well validated in pediatric patients)
The ratio of AR jet to the LVOT just below the AV ( not well
validated in pediatric patients)
Mild if ˂ 25%, severe if ≥ 65%

Regurgitant volume (ml/beat)

Regurgitant fraction (%)
Effective Regurgitant Orifice area (mm2 )
 Aortic Prosthetic Valves

Percutaneous or surgical AV repair

AV replacement (AVR):
-Significant valve destruction
-After repair or intervention failure.
Mechanical valves
Tissue valves or bioprosthesis.

The criteria of assessment of aortic

prosthesis :

Valve seating and motion

Regurgitation/obstruction
Thrombosis or degeneration
 Summary
AS/AR
Valve/ LVOT anatomy
Quantitation of severity
Measurements
Associations
AS
Level(s) of obstruction

Mechanical valves
Mechanical shadowing
Aortic bioprosthesis
Resemble native tissue
THANKS