Aortic Transvalvular Gradient Mis-Quantification

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Mitral regurgitation (MR) can present diagnostic challenges on echocardiography, sometimes mimicking aortic stenosis (AS).
• Accurate differentiation is vital for appropriate patient management and surgical intervention.

Purpose of the Study:

• To present a case where mitral regurgitation mimicked aortic stenosis on echocardiography.
• To highlight the importance of detailed Doppler signal analysis and transesophageal echocardiography (TEE) in differentiating these conditions.

Main Methods:

• Case report of a 55-year-old male undergoing mitral valve surgery for severe MR.
• Preoperative transthoracic echocardiography and intraoperative TEE, including 2D and 3D imaging.
• Detailed Doppler analysis focusing on signal timing and envelope characteristics.

Main Results:

• Initial intraoperative TEE suggested mild-to-moderate AS due to a high aortic gradient.
• Advanced Doppler analysis revealed a double envelope signal, identifying eccentric MR and true aortic flow.
• 3D TEE confirmed normal aortic valve morphology and function, ruling out AS.

Conclusions:

• Echocardiographic findings of MR can mimic AS, necessitating careful evaluation.
• Doppler signal timing analysis is critical for distinguishing MR from AS during echocardiography.
• Systematic echocardiographic assessment prevents misdiagnosis and ensures correct intraoperative decision-making.