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Aortic Valve

  • Michael BenggonEmail author
  • Thomas Griffiths
Chapter
  • 1.8k Downloads

Abstract

Echocardiographic evaluation of the aortic valve is not limited to just the valve leaflets itself but also should include the left ventricular outflow tract, sinuses of Valsalva, and the sinotubular junction. Echocardiographic evaluation of any valve pathology should include a thorough two-dimensional examination of the valve and associated anatomic findings, color flow Doppler interrogation, and spectral Doppler analysis. Aortic stenosis is one of the most common cardiac pathologies and can be caused by atherosclerotic thickening over time, congenital bicuspid disease, or rheumatic heart disease. The severity of the stenosis can be assessed by planimetry, spectral Doppler analysis using the continuity equation, mean gradient measurement, and by evaluation of color flow through the valve leaflets. Aortic regurgitation may be caused by root dilatation from vascular or connective tissue disease processes as well as leaflet pathology. Color flow Doppler analysis is a key to determining disease severity through measurement of the vena contracta and jet width to left ventricular outflow diameter. Measurement of the aortic regurgitation pressure half time and determining if there is any reversal of blood flow within the descending aorta will also help to assess disease severity.

Keywords

Aortic valve Aortic Valve Aortic stenosis Aortic regurgitation Aortic insufficiency 

Supplementary material

Video 7.1

Aortic Stenosis: A ME AV SAX view of a severely calcified aortic valve. Notice the clear distinction of the three leaflets ruling out congenital bicuspid disease (AVI 9,309 KB)

Video 7.2

Bicuspid aortic stenosis: A mid-esophageal aortic valve short axis view of a congenital bicuspid aortic valve (AVI 3,677 KB)

Video 7.3

Flow Acceleration and Turbulence: A ME AV LAX view of flow acceleration in the LVOT as blood flow moves into a stenotic aortic valve orifice. Note the concentric or hemispheric color pattern. High velocity flow distal to the valve causes a turbulent heterogenous color pattern (versus a laminar homogenous color pattern in normal flow) (AVI 10,950 KB)

Video 7.4

Malcoaptation: A ME AV LAX view in a patient with bicuspid aortic valve disease and a dilated annulus and aortic root (AVI 3,522 KB)

Video 7.5

Aortic Regurgitation: A ME AV LAX view in a patient with an ascending aortic dissection and severe aortic regurgitation (AVI 1,514 KB)

References

  1. 1.
    Bellhouse BJ, Bellhouse FH. Mechanism of closure of the aortic valve. Nature 1968;217:86–87.Google Scholar
  2. 2.
    Tribouilloy CM, et al. Circulation. 2000;102:558–64.CrossRefPubMedGoogle Scholar
  3. 3.
    Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J 1988;9(Suppl E):57–64.Google Scholar
  4. 4.
    Nadir MA, Wei L, Elder D, Libianto R, Lim T, et al. Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis. J Am Coll Cardiol. 2011;58(6):570–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American society of echocardiography and the Society of cardiovascular aneshesiologists. J Am Soc Echocardiogr. 2013;26:443–56.CrossRefPubMedGoogle Scholar
  6. 6.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Godley RW, Green D, Dillon JC, Rogers EW, Feigenbaum H, Weyman AE. Reliability of two-dimensional echocardiography in assessing the severity of valvular aortic stenosis. Chest. 1981;79:657–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Lindman B, Bonow R, Otto C. Current management of calcific aortic stenosis. Circ Res. 2013;113:223–37.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bekeredijian R, Grayburn P. Valvular heart disease: aortic regurgitation. Circulation. 2005;112:125–34.CrossRefGoogle Scholar
  10. 10.
    Lancellotti P, Tribouilloy C, et al. European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(3):223–244.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of AnesthesiologyLoma Linda UniversityLoma LindaUSA
  2. 2.Department of AnesthesiologyUniversity of California San DiegoSan DiegoUSA

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