Echocardiography, TTE findings
Minimal excursion of the aortic valve leaflet
Calcifications of AV
Systolic "doming" on parasternal long
Turbulent flow through AV on color doppler
LV hypertrophy
Number of leaflets (unicuspid, bicuspid, tricuspid, quadricuspid)
Raphe in bicuspid aortic valve in diastole may false negatively appear like trileaflet valve
Only comment on the number of leaflets in systole in parasternal short axis
Severity by continuous wave (CW) Doppler peak velocity (m/s)
AS is unlikely if peak CW velocity well below 2.5 m/s, and AVA measurements may not be necessary
Ensure parallel intercept angle across aortic valve in apical view
< 2.5 = aortic sclerosis
2.6 - 2.9 = mild
3.0 - 4.0 = moderate
> 4.0 = severe
Aortic valve area (AVA) requires LVOT diameter (D) and velocity time integral (VTI) at LVOT and AV in the continuity equation
More reliable than CW doppler peak velocity
Obtain LVOT diameter just apical to AV in PSL at maximal systole
Obtain the following in apical view at the aortic valve as parallel to flow as possible to avoid falsely low values
AV VTI (continuous wave doppler), gate at tips of AV opening in systole, tracing below the line in systole
LVOT VTI (pulse wave doppler), gate in LVOT just apical to AV, tracing below the line in systole<unk>  valve area severity
Normal, > 2.5 cm²
Mild, 2.5 - 1.5 cm²
Moderate, 1.0 - 1.5 cm²
Severe, < 1.0 cm²
Minimal excursion of the aortic valve leaflet
Calcifications of AV
Systolic "doming" on parasternal long
Turbulent flow through AV on color doppler
LV hypertrophy
Number of leaflets (unicuspid, bicuspid, tricuspid, quadricuspid)
Raphe in bicuspid aortic valve in diastole may false negatively appear like trileaflet valve
Only comment on the number of leaflets in systole in parasternal short axis
Raphe in bicuspid aortic valve in diastole may false negatively appear like trileaflet valve
Only comment on the number of leaflets in systole in parasternal short axis
AS is unlikely if peak CW velocity well below 2.5 m/s, and AVA measurements may not be necessary
Ensure parallel intercept angle across aortic valve in apical view
< 2.5 = aortic sclerosis
2.6 - 2.9 = mild
3.0 - 4.0 = moderate
> 4.0 = severe
More reliable than CW doppler peak velocity
Obtain LVOT diameter just apical to AV in PSL at maximal systole
Obtain the following in apical view at the aortic valve as parallel to flow as possible to avoid falsely low values
AV VTI (continuous wave doppler), gate at tips of AV opening in systole, tracing below the line in systole
LVOT VTI (pulse wave doppler), gate in LVOT just apical to AV, tracing below the line in systole<unk>  valve area severity
Normal, > 2.5 cm²
Mild, 2.5 - 1.5 cm²
Moderate, 1.0 - 1.5 cm²
Severe, < 1.0 cm²
AV VTI (continuous wave doppler), gate at tips of AV opening in systole, tracing below the line in systole
LVOT VTI (pulse wave doppler), gate in LVOT just apical to AV, tracing below the line in systole
Normal, > 2.5 cm²
Mild, 2.5 - 1.5 cm²
Moderate, 1.0 - 1.5 cm²
Severe, < 1.0 cm²
Caveats in TTE for AS
Eccentric mitral regurgitation jets may interfere with AV flows
Atrial fibrillation poses different levels of diastolic and systolic filling, requiring multiple tracings
Poor LV function may reduce velocities upon measuring, while AS may still be present
Eccentric mitral regurgitation jets may interfere with AV flows
Atrial fibrillation poses different levels of diastolic and systolic filling, requiring multiple tracings
Poor LV function may reduce velocities upon measuring, while AS may still be present
Aortic stenosis
Mitral stenosis
Mitral regurgitation
Aortic regurgitation
Mitral valve prolapse
Left ventricular hypertrophy
Left atrial enlargement
Stone heart