Aortic valve area in aortic stenosis
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
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 . 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 "Clinical manifestations and diagnosis of 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 .
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
- 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.
- 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.
- Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline 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. J Am Coll Cardiol 2014; 63:e57.
- 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.
- Feigenbaum H. Echocardiography, 5th ed, Feigenbaum H (Ed), Lea and Febiger, Philadelphia 1994. p.239.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Bahlmann E, Gerdts E, Cramariuc D, et al. Prognostic value of energy loss index in asymptomatic aortic stenosis. Circulation 2013; 127:1149.
- 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.
- Hoffmann R, Flachskampf FA, Hanrath P. Planimetry of orifice area in aortic stenosis using multiplane transesophageal echocardiography. J Am Coll Cardiol 1993; 22:529.
- Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol 2006; 47:2141.
- Baumgartner H. Hemodynamic assessment of aortic stenosis: are there still lessons to learn? J Am Coll Cardiol 2006; 47:138.
- Defrance C, Bollache E, Kachenoura N, et al. Evaluation of aortic valve stenosis using cardiovascular magnetic resonance: comparison of an original semiautomated analysis of phase-contrast cardiovascular magnetic resonance with Doppler echocardiography. Circ Cardiovasc Imaging 2012; 5:604.
- Tanaka K, Makaryus AN, Wolff SD. Correlation of aortic valve area obtained by the velocity-encoded phase contrast continuity method to direct planimetry using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2007; 9:799.
- 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.
- Pouleur AC, le Polain de Waroux JB, Pasquet A, et al. Planimetric and continuity equation assessment of aortic valve area: Head to head comparison between cardiac magnetic resonance and echocardiography. J Magn Reson Imaging 2007; 26:1436.
- Abdulla J, Sivertsen J, Kofoed KF, et al. Evaluation of aortic valve stenosis by cardiac multislice computed tomography compared with echocardiography: a systematic review and meta-analysis. J Heart Valve Dis 2009; 18:634.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Laskey WK, Kussmaul WG. Subvalvular gradients in patients with valvular aortic stenosis: prevalence, magnitude, and physiological importance. Circulation 2001; 104:1019.
- McMILLAN IK. Aortic stenosis; a post-mortem cinephotographic study of valve action. Br Heart J 1955; 17:56.
- WOOD P. Aortic stenosis. Am J Cardiol 1958; 1:553.
- Rosenhek R, Zilberszac R, Schemper M, et al. Natural history of very severe aortic stenosis. Circulation 2010; 121:151.
- Bache RJ, Wang Y, Jorgensen CR. Hemodynamic effects of exercise in isolated valvular aortic stenosis. Circulation 1971; 44:1003.
- 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.
- Doppler echocardiography
- - Pressure gradient
- - Aortic valve area by continuity principle
- - Aortic valve resistance
- - Energy loss index
- - Rate of change in aortic valve area
- Planimetry of aortic valve area
- OTHER NONINVASIVE IMAGING
- Cardiovascular magnetic resonance
- Computed tomography
- CARDIAC CATHETERIZATION
- Gorlin equation for aortic valve area
- Aortic valve resistance
- Subvalvular gradients
- CRITICAL VALVE AREA AND SEVERITY
- Valve area and symptoms
- Indexing for body size
- LOW GRADIENT AORTIC STENOSIS