The contemporary role of echocardiography in the assessment and management of aortic stenosis

  • Takeshi KitaiEmail author
  • Rayji S. Tsutsui
Special Feature: Review Article Echocardiographic management of valvular heart disease


Aortic stenosis (AS) represents a major healthcare issue because of its ever-increasing prevalence, poor prognosis, and complex pathophysiology. Echocardiography plays a central role in providing a comprehensive morphological and hemodynamic evaluation of AS. The diagnosis of severe AS is currently based on three hemodynamic parameters including maximal jet velocity, mean pressure gradient (mPG) across the aortic valve, and aortic valve area (AVA). However, inconsistent grading of AS severity is common when the AVA is < 1.0 cm2 but the mPG is < 40 mmHg, also known as low-gradient AS (LGAS). Special attention should be paid to patients with symptomatic LGAS with low stroke volume and/or low ejection fraction because this entity is more difficult to diagnose and has a worse prognosis. Stress echocardiography testing plays an important role in this disease entity. Elderly patients with prohibitive comorbidities for surgical aortic valve replacement (AVR) were without procedural options until the advent of transcatheter AVR (TAVR), which has dramatically changed these circumstances. Along with computed tomography, echocardiography plays a vital role in the periprocedural assessment of the aortic valve and surrounding apparatus. This review describes the evolution of the role of echocardiography in the diagnosis and management of AS, the complexity of the aortic apparatus, and the increased need for expert use of three-dimensional echocardiography.


Aortic stenosis Valvular heart disease Echocardiography 


Compliance with ethical standards

Conflict of interest

Takeshi Kitai, and Rayji S. Tsutsui declare that they have no conflicts of interest.

Ethical statements

None of the procedures or experimentations was used in the current manuscript.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
  2. 2.Center for Clinical ResearchKobe City Medical Center General HospitalKobeJapan
  3. 3.Heart and Vascular Institute, Department of Cardiovascular MedicineCleveland ClinicClevelandUSA

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