DIAGNOSTIC METHODS DOPPLER ECHOCARDIOGRlAPHY Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography

ABSTRACT Laminar flow through a conduit is equal to the mean velocity times the cross-sectional area of the orifice. Therefore, volume is equal to the time-velocity integral multiplied by the cross-sectional area. In aortic stenosis, flow in the stenotic jet is laminar and the aortic valve area should be equal to the volume of blood ejected through the valve divided by the time-velocity integral of the aortic jet velocity recorded by continuous-wave Doppler echocardiography. To test whether this concept can be used to accurately determine aortic valve area noninvasively by the Doppler method, 39 patients (age 35 to 82 years, mean 63) underwent pulsed Doppler combined with two-dimensional echocardiog-raphy for measurement of stroke volume at the aortic, pulmonic, and mitral anulus as well as continu-ous-wave Doppler recording of the aortic jet. Aortic valve area determined at cardiac catheterization by the Gorlin equation ranged between 0.4 and 2.07 cm2 (mean 0.89 + 0.45). Doppler-derived valve area, determined with the stroke volume value from either the aortic, pulmonic, or mitral anulus, correlated well with the area determined at cardiac catheterization (r =.95,.97, and.96, respectively). A simplified method for measuring aortic valve area derived as the cross-sectional area of the aortic anulus times peak velocity just proximal to the aortic valve divided by peak aortic jet velocity correlated well with measurements obtained at cardiac catheterization (r =.94). An excellent separation between critical and noncritical aortic stenosis was seen using either one of the Doppler methods. Thus, combined pulsed and continuous-wave Doppler can be used to accurately measure valve area in adult patients with aortic stenosis