Author + information
- Dia Smiley,
- Korey Haddox,
- David Harris and
- Mouhamad Abdallah
Transthoracic echocardiography (TTE) determination of aortic valve (AV) stenosis severity is dependent on proper alignment for ideal interrogation of the valve. Eccentric jets or off angle measurements decrease the accuracy of TTE by underestimating stenosis severity and may inappropriately delay aortic valve replacement (AVR).
A 37 year-old female with a known bicuspid AV presented with chest pain, dyspnea, and recurrent syncope. TTE revealed a left ventricular ejection fraction of 65%, moderately calcified AV with reduced leaflet mobility and an eccentric AV jet. The mean and peak gradients were 21 mmHg and 36 mmHg, suggesting mild to moderate stenosis. Computed tomography scan measured her aortic root diameter at 4.2 x 4.6 cm.
Given the discrepancy between symptoms and TTE findings, the patient attempted an exercise bicycle stress echocardiogram, which was discontinued after 25 Watts due to excessive back pain. Her AV area on the bicycle stress test was 1.2cm2. Subsequently, on cardiac catheterization, a catheter was unable to cross the aortic valve, but a wire was passed successfully. She ultimately underwent AVR and aortic root grafting. In the operating room, her AV was heavily calcified with an orifice diameter of <1 cm2 (Image).
The severity of AV stenosis is frequently underestimated on TTE when eccentric jets are involved, and careful examination and additional testing are indicated if there is a discrepancy in symptoms and TTE results.
Monday, March 31, 2014, 9:45 a.m.-10:30 a.m.
Session Title: FIT Clinical Decision Making: Valvular and Pericardial Disease
Abstract Category: Valvular Heart Disease
Presentation Number: 1246-02
- 2014 American College of Cardiology Foundation