Noninvasive assessment and differentiation of left ventricular outflow obstruction with Doppler ultrasound

Blood flow velocities in the left ventricle and the ascending aorta were recorded noninvasively with Doppler ultrasound. The ultrasound beam was aligned as much as possible to the direction of velocity, using the frequency shift in the audio signal as a guide to obtain velocities as close as possible to those present. From the maximal velocity recorded by continuous-wave Doppler, a peak pressure drop was calculated in 24 patients with aortic valve stenosis and nine with fixed subaortic stenosis. Fourteen patients with aortic stenosis and three with fixed subaortic stenosis were catheterized. In these patients, the correlation between calculated pressure drops and those obtained by pressure recording was good (r = 0.85). The pressure drop can be underestimated by underestimating velocity, but cannot be overestimated. With pulsed Doppler, the level of obstruction can be determined.