Aortic valve area in aortic stenosis


In individuals with normal aortic valves, the valve area is 3.0 to 4.0 cm2. As aortic stenosis develops, minimal valve gradient is present until the orifice area becomes less than half of normal. The pressure gradient across a stenotic valve is directly related to the valve orifice area and the transvalvular flow [1]. As a result, in the presence of a depressed cardiac output, relatively low pressure gradients can be seen in some patients with severe aortic stenosis. (See "Low flow, low gradient severe aortic stenosis".) On the other hand, during exercise or other high flow states, systolic impulse-gradients can be measured in patients with minimally stenotic or even normal valves [2].

Complete assessment of the degree of aortic stenosis requires:

  • Measurement of the transvalvular flow
  • Determination of the transvalvular pressure gradient
  • Calculation of the aortic valve area

There is wide variability in the relationship between the severity of stenosis and symptom onset. In general, symptoms in patients with aortic stenosis occur when the valve area is <1.0 cm2 or the mean transvalvular gradient exceeds 50 mmHg (table 1). (See "Natural history of aortic stenosis in adults".)

This topic will review the methods of techniques for calculating the aortic valve area and valve resistance in patients with aortic stenosis. A discussion of the use of echocardiography in the evaluation of aortic stenosis is presented separately. (See "Echocardiographic evaluation of the aortic valve" and "Transesophageal echocardiography in the evaluation of aortic valve disease".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: Feb 26, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
  1. GORLIN R, GORLIN SG. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J 1951; 41:1.
  2. Murgo, JP, Altobelli, SA, Dorethy, JF, et al. Normal ventricular ejection dynamics in man during rest and exercise. Am Heart Assoc Monogr 1975; 46:92.
  3. Hirshfeld JW, Kolansky DM. Valve function: Stenosis and regurgitation. In: Diagnostic and Therapeutic Cardiac Catheterization, 2nd ed, Pepine CJ, Hill JA, Lambert CR (Eds), Williams & Wilkins, Baltimore 1994. p.443.
  4. Carabello BA, Grossman W. Calculation of stenotic valve orifice area. In: Cardiac Catheterization and Angiography, 3rd ed, Grossman W (Ed), Lea and Febiger, Philadelphia 1986. p.143.
  5. Adele C, Vaitkus PT, Tischler MD. Evaluation of the significance of a transvalvular catheter on aortic valve gradient in aortic stenosis: a direct hemodynamic and Doppler echocardiographic study. Am J Cardiol 1997; 79:513.
  6. Bermejo J, Rojo-Alvarez JL, Antoranz JC, et al. Estimation of the end of ejection in aortic stenosis: an unreported source of error in the invasive assessment of severity. Circulation 2004; 110:1114.
  7. Badano L, Cassottano P, Bertoli D, et al. Changes in effective aortic valve area during ejection in adults with aortic stenosis. Am J Cardiol 1996; 78:1023.
  8. Ford LE, Feldman T, Chiu YC, Carroll JD. Hemodynamic resistance as a measure of functional impairment in aortic valvular stenosis. Circ Res 1990; 66:1.
  9. Bermejo J, Antoranz JC, Burwash IG, et al. In-vivo analysis of the instantaneous transvalvular pressure difference-flow relationship in aortic valve stenosis: implications of unsteady fluid-dynamics for the clinical assessment of disease severity. J Heart Valve Dis 2002; 11:557.
  10. Kadem L, Rieu R, Dumesnil JG, et al. Flow-dependent changes in Doppler-derived aortic valve effective orifice area are real and not due to artifact. J Am Coll Cardiol 2006; 47:131.
  11. Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol 2006; 47:2141.
  12. Laskey WK, Kussmaul WG. Subvalvular gradients in patients with valvular aortic stenosis: prevalence, magnitude, and physiological importance. Circulation 2001; 104:1019.
  13. Cannon JD Jr, Zile MR, Crawford FA Jr, Carabello BA. Aortic valve resistance as an adjunct to the Gorlin formula in assessing the severity of aortic stenosis in symptomatic patients. J Am Coll Cardiol 1992; 20:1517.
  14. Feigenbaum H. Echocardiography, 5th ed, Feigenbaum H (Ed), Lea and Febiger, Philadelphia 1994. p.239.
  15. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009; 22:1.
  16. Arsenault M, Masani N, Magni G, et al. Variation of anatomic valve area during ejection in patients with valvular aortic stenosis evaluated by two-dimensional echocardiographic planimetry: comparison with traditional Doppler data. J Am Coll Cardiol 1998; 32:1931.
  17. Lester SJ, McElhinney DB, Miller JP, et al. Rate of change in aortic valve area during a cardiac cycle can predict the rate of hemodynamic progression of aortic stenosis. Circulation 2000; 101:1947.
  18. Ho PP, Pauls GL, Lamberton DF, et al. Doppler derived aortic valve resistance in aortic stenosis: its hemodynamic validation. J Heart Valve Dis 1994; 3:283.
  19. Bermejo J, García-Fernández MA, Torrecilla EG, et al. Effects of dobutamine on Doppler echocardiographic indexes of aortic stenosis. J Am Coll Cardiol 1996; 28:1206.
  20. Tardif JC, Rodrigues AG, Hardy JF, et al. Simultaneous determination of aortic valve area by the Gorlin formula and by transesophageal echocardiography under different transvalvular flow conditions. Evidence that anatomic aortic valve area does not change with variations in flow in aortic stenosis. J Am Coll Cardiol 1997; 29:1296.
  21. Shively BK, Charlton GA, Crawford MH, Chaney RK. Flow dependence of valve area in aortic stenosis: relation to valve morphology. J Am Coll Cardiol 1998; 31:654.
  22. Saad RM, Barbetseas J, Olmos L, et al. Application of the continuity equation and valve resistance to the evaluation of St. Jude Medical prosthetic aortic valve dysfunction. Am J Cardiol 1997; 80:1239.
  23. Roger VL, Seward JB, Bailey KR, et al. Aortic valve resistance in aortic stenosis: Doppler echocardiographic study and surgical correlation. Am Heart J 1997; 134:924.
  24. Garcia D, Pibarot P, Dumesnil JG, et al. Assessment of aortic valve stenosis severity: A new index based on the energy loss concept. Circulation 2000; 101:765.
  25. Garcia D, Dumesnil JG, Durand LG, et al. Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity. J Am Coll Cardiol 2003; 41:435.
  26. Kim CJ, Berglund H, Nishioka T, et al. Correspondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization. Am Heart J 1996; 132:1163.
  27. Stoddard MF, Arce J, Liddell NE, et al. Two-dimensional transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis. Am Heart J 1991; 122:1415.
  28. Hoffmann R, Flachskampf FA, Hanrath P. Planimetry of orifice area in aortic stenosis using multiplane transesophageal echocardiography. J Am Coll Cardiol 1993; 22:529.
  29. Baumgartner H. Hemodynamic assessment of aortic stenosis: are there still lessons to learn? J Am Coll Cardiol 2006; 47:138.
  30. John AS, Dill T, Brandt RR, et al. Magnetic resonance to assess the aortic valve area in aortic stenosis: how does it compare to current diagnostic standards? J Am Coll Cardiol 2003; 42:519.
  31. Feuchtner GM, Dichtl W, Friedrich GJ, et al. Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol 2006; 47:1410.
  32. McMILLAN IK. Aortic stenosis; a post-mortem cinephotographic study of valve action. Br Heart J 1955; 17:56.
  33. WOOD P. Aortic stenosis. Am J Cardiol 1958; 1:553.
  34. Rosenhek R, Zilberszac R, Schemper M, et al. Natural history of very severe aortic stenosis. Circulation 2010; 121:151.
  35. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.
  36. Bache RJ, Wang Y, Jorgensen CR. Hemodynamic effects of exercise in isolated valvular aortic stenosis. Circulation 1971; 44:1003.
  37. deFilippi CR, Willett DL, Brickner ME, et al. Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. Am J Cardiol 1995; 75:191.