Assessment of aortic and pulmonic stenosis by echocardiography

Doppler and imaging echocardiography are highly useful methods of identifying and quantifying both aortic and pulmonic stenosis. The presence of valve stenosis and associated regurgitation is based on detecting abnormal intracardiac velocity patterns near the affected valve. Defining the specific valve involved and the type of lesion present is based on determining the location and timing of the abnormal velocities. Both color flow imaging and duplex pulsed Doppler with two-dimensional echocardiographic imaging are highly accurate in identifying the lesions present. Quantification of the severity of stenotic lesions requires calculation of the pressure gradient across the valve and estimation of valve area; quantification of volume flow rate is frequently helpful. The pressure gradient is calculated from high velocity data acquired in the stenotic valve orifice by using the Bernoulli equation. Volume flow rate through the valve can be estimated by using Doppler velocity data and two-dimensional echocardiographic imaging data acquired at sites upstream from the stenotic valve. The continuity equation allows calculation of valve area that is based on this noninvasive stroke volume and pressure gradient data. This review characterizes flow patterns present near stenotic valves, discusses the equations required to quantify aortic and pulmonic stenosis, and then describes the clinical approach to the noninvasive quantification of both stenotic lesions.