[Severity of aortic stenosis assessed by Doppler techniques].
Continuous wave (CW) Doppler ultrasound has facilitated accurate estimates of pressure gradient (PG) across a stenotic valve. However, the severity of stenosis cannot be assessed using PG alone because it is dependent on actual flow across the valve. In this study, Doppler techniques were used to predict PG and aortic valve areas (AVA) in adults with aortic stenosis (AS). Fifty-four adult patients undergoing cardiac catheterization for suspected AS were prospectively evaluated. There were 28 men and 26 women, who ranged in age from 25 to 68 years with a mean of 56 years. These Doppler ultrasound studies were performed using a 2 MHz transducer and an Aloka SSD-730. With CW Doppler ultrasound, the highest velocities of the aortic jet were recorded from an apical approach. Left ventricular outflow flows were recorded about 1.0-1.5 cm below the aortic annulus using high PRF. Doppler waveforms were analyzed for the AT/ET (AT: acceleration time, ET: ejection time), and Doppler PG was calculated from the maximum velocity (V) of the aortic jet based on a modified Bernoulli equation (PG = 4V2), and aortic valve area was obtained using the continuity equation-(AVA = left ventricular outflow tract stroke volume divided by AS jet velocity integral). These data were compared with hemodynamic data obtained from cardiac catheterization. The following results were obtained: 1. In eight patients with substantial aortic regurgitation, whose maximum catheter PG were from 20 to 45 mmHg, the AT/ET was less than 0.30. The ratio of AT/ET correlated with the peak velocity of the aortic jet (r = 0.88) and the maximum PG (r = 0.87) obtained from cardiac catheterization. 2. In 46 patients with AS, the maximum PG by CW Doppler showed an excellent correlation with maximum catheterization PG (r = 0.97, SEE 6 mmHg), and the mean PG as calculated by the two techniques also disclosed a good correlation (r = 0.97, SEE 5.4 mmHg).(ABSTRACT TRUNCATED AT 400 WORDS)
Nakamura
K
K
Heart Institute of Japan, Tokyo Women's Medical College.
Shiina
T
T
Satomi
G
G
Sakai
K
K
Tamura
K
K
Matsumura
K
K
Umemura
J
J
Magosaki
N
N
Koyanagi
H
H
Hirosawa
K
K
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography