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The mystery of defining aortic valve area: what have we learnt from three-dimensional imaging modalities?

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Abstract

Aortic valve area is one of the main criteria used by echocardiography to determine the degree of valvular aortic stenosis, and it is calculated using the continuity equation which assumes that the flow volume of blood is equal at two points, the aortic valve area and the left ventricular outflow tract (LVOT). The main fallacy of this equation is the assumption that the LVOT area which is used to calculate the flow volume at the LVOT level is circular, where it is often an ellipse and sometimes irregular. The aim of this review is to explain the physiology of the continuity equation, the different sources of errors, the added benefits of using three-dimensional imaging modalities to measure LVOT area, the latest recommendations related to valvular aortic stenosis, and to introduce future perspectives. A literature review of studies comparing aortic valve area and LVOT area, after using three-dimensional data, has shown underestimation of both measurements when using the continuity equation. This has more impact on patients with discordant echocardiographic measurements when aortic valve area is disproportionate to haemodynamic measurements in assessing the degree of aortic stenosis. Although fusion imaging modalities of LVOT area can help in certain group of patients to address the issue of aortic valve area underestimation, further research on introducing a correction factor to the conventional continuity equation might be more rewarding, saving patients additional tests and potential radiation, with no clear evidence of cost-effectiveness.

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Acknowledgements

We are grateful to Dr Richard Talbot for proof reading the article.

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Authors and Affiliations

  1. Milton Keynes University Hospital, Standing Way, Eaglestone, Milton Keynes, UK

    Ebraham Alskaf & Attila Kardos

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  1. Ebraham Alskaf
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Correspondence to Ebraham Alskaf.

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A (Ebraham Alskaf) and B (Attila Kardos) declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

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Informed consent was obtained from all patients for being included in the study.

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Alskaf, E., Kardos, A. The mystery of defining aortic valve area: what have we learnt from three-dimensional imaging modalities?. J Echocardiogr 16, 130–138 (2018). https://doi.org/10.1007/s12574-018-0374-8

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  • DOI: https://doi.org/10.1007/s12574-018-0374-8

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