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Changes in effective aortic valve area during ejection in adults with aortic stenosis
L Badano1, P Cassottano, D Bertoli
1Servizio di Cordiologia, Ospedale di Neiv, Genoa, Italy.
The American Journal of Cardiology
|November 1, 1996
Summary
In aortic stenosis, the effective aortic valve area changes during ejection, unlike in healthy individuals. This dynamic change may mean single measurements inadequately assess stenosis severity.
Area of Science:
- Cardiovascular Medicine
- Echocardiography
- Hemodynamics
Background:
- Aortic stenosis (AS) assessment typically assumes constant valve orifice area during ejection.
- Recent findings suggest calcific AS valve area may vary with flow conditions.
- This challenges the reliability of single-point measurements for stenosis severity.
Purpose of the Study:
- To test the hypothesis that in vivo effective aortic orifice area (EOA) in AS changes continuously during ejection.
- To determine if single EOA measurements are adequate indicators of AS severity.
Main Methods:
- Doppler echocardiography was used to measure flow velocity in 26 AS patients and 14 controls.
- Instantaneous EOA was calculated at mid-acceleration, peak velocity, and mid-deceleration.
- Calculations were performed in the ascending aorta and left ventricular outflow tract.
Main Results:
- In AS patients, EOA varied significantly during ejection (e.g., 84% at mid-acceleration, 113% at mid-deceleration relative to peak velocity).
- In normal subjects, EOA remained constant throughout ejection (97-99% of peak velocity values).
- The percentage change in EOA in AS patients was wide and independent of mean gradient or peak EOA.
Conclusions:
- Effective aortic valve area dynamically changes during ejection in patients with aortic stenosis.
- This variability is not related to standard indices of stenosis severity.
- Constant EOA during ejection is characteristic of normal aortic valves, not stenotic ones.