[Echocardiography in the diagnosis of severe aortic valve stenosis in adults].
A series of 45 adults with severe valvular aortic stenosis underwent echocardiographic examination before surgery. The echocardiographic indices of the severity of the stenosis were reviewed: In M mode: aortic valve opening was only clearly defined and quantifiable in 22 out of 45 cases. In these 22 cases, the separation of the valves was variable in 9 cases; the stenosis was underestimated in 2 cases both of which were unsuspected bicuspid valves; the stenosis were overestimated in 1 case leading to an erroneous diagnosis. In 2D: aortic valve opening was easier to detect than in M mode; it was quantifiable in 16 out of 21 patients (80 p. 100). The subcostal view was particularly valuable in patients with chronic pulmonary disease or with barrel-shaped chests. The 2D examination however, suffers from the same limitations as M mode: variability in the values of aortic valve opening in a third of cases and a general tendency to overestimate the severity of the stenosis. In two cases an erroneous diagnosis of severe stenosis was made in cases of simple aortic sclerosis either because of the inability to visualise a mobile 3rd left anterior cusp in the long axis view or because of artefact due to paravalvular calcification. The most reliable index of severity was the thickness of the left ventricular posterior wall: this measurement was never less than 13 mm, with a mean value of 15,8 +/- 1,8 mm in the 43 patients in whom it was measured. The measurement was also of prognostic significance; paradoxical thinning of the posterior wall and septum was a poor prognostic sign which was associated with cardiac failure and passive dilatation of the left ventricle sometimes shortly preceding sudden death. In the absence of cardiac failure, a posterior wall thickness of less than 13 mm excludes surgical aortic stenosis.
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D002114:Calcinosis / Q000175:diagnosis; D004452:Echocardiography; D006801:Humans; D008875:Middle Aged
Apport de l'échocardiographie au diagnostic des sténoses aortiques valvulaires sévères de l'adulte.