Franey, Laura M.

In patients with aortic stenosis (AS) and eccentric transaortic flow, greater pressure loss occurs as the jet collides with the aortic wall together with delayed and diminished pressure recovery. This leads to the elevated transaortic valve pressure gradients noted on both Doppler and cardiac catheterization. Such situations may present a diagnostic dilemma where traditional measures of stenosis severity indicate severe AS, while imaging modalities of the aortic valve geometric aortic valve area (GOA) suggest less than severe stenosis. In this study, we present a series of cases exemplifying this clinical dilemma and demonstrate how color M‐mode, 2D and 3D transthoracic (TTE) and transesophageal (TEE) echocardiography, cardiac computed tomography angiography (CTA), and magnetic resonance imaging (MRI), may be used to resolve such discrepancies.

ObjectivesThe clinical severity of aortic stenosis (AS) is based largely on symptoms. However, AS severity is primarily determined by estimating the aortic valve area (AVA) and pressure gradients (ΔP). Conditions may arise in which there is a mismatch in severity between AVA and ΔP determinations secondary to errors in measurement and/or assumption, alterations of flow, or variations in the magnitude of pressure recovery. The cause of discrepancy between area and gradient determinations must be deciphered so as to best counsel patients on the most ideal treatment strategy. (J Interven Cardiol 2013;26:183–194)