title: The role of jet eccentricity in generating disproportionately elevated transaortic pressure gradients in patients with aortic stenosis.
abstract: In patients with aortic stenosis (AS) and eccentric transaortic flow, greater pressure loss occurs as the jet collides with the aortic wall together with delayed and diminished pressure recovery. This leads to the elevated transaortic valve pressure gradients noted on both Doppler and cardiac catheterization. Such situations may present a diagnostic dilemma where traditional measures of stenosis severity indicate severe AS, while imaging modalities of the aortic valve geometric aortic valve area (GOA) suggest less than severe stenosis. In this study, we present a series of cases exemplifying this clinical dilemma and demonstrate how color M-mode, 2D and 3D transthoracic (TTE) and transesophageal (TEE) echocardiography, cardiac computed tomography angiography (CTA), and magnetic resonance imaging (MRI), may be used to resolve such discrepancies.
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health Systems, Royal Oak, Michigan.
authors.forename: Amr E
authors.initials: AE
authors.lastname: Abbas
authors.forename: Laura M
authors.initials: LM
authors.lastname: Franey
authors.forename: Steven
authors.initials: S
authors.lastname: Lester
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gallagher
authors.forename: George
authors.initials: G
authors.lastname: Hanzel
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
keywords: aortic valve stenosis; echocardiography; jet eccentricity