Assessment of Aortic Stenosis

Aortic stenosis is commonly due to the following conditions1 

• Bicuspid valve - common in Europe, usually associated with calcification 
• Calcification 
• Rheumatic heart disease - common in rest of the world

1. Bicuspid valve 

• Most often due to fusion of right and left coronary cusps  
• Rarely due to fusion of left and non-coronary cusps  
• Best appreciated in systole as an oval or elliptical orifice (see video)
• Common cause for aortic stenosis especially when associated with calcification

 As you can see above, the aortic valve is elliptical and M-Mode shows an eccentric closure line.

2. Calcific aortic stenosis 

• Valve is mildly to heavily calcified 
• Calcification is predictive of long term outcomes

3. Rheumatic heart disease 

• Calcification along the cusp edges results in restricted opening 
• More often involves the mitral valve rather than aortic valve

Previous studies have shown the following to be important predictors of cardiovascular outcomes2 

• Rate of change in aortic jet velocity 
• Degree of aortic calcification

These recent parameters may suggest that  it is not essential to have symptoms for the patient to be referred for aortic valve surgery.

Of course, it also may be important to perform cardiopulmonary exercise testing to record the actual physical impact it has on the
patient.

References

1.  Helmut Baumgartner, Judy Hung, Javier Bermejo, John B. Chambers,Arturo Evangelista, Brian P. Griffin, Bernard Iung, Catherine M. Otto, Patricia 

A. Pellikka,and Miguel Quiñones. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice Eur J Echocardiogr 

(2009) 10(1): 1-25

2.  Rosenhek R,  Binder T, Porenta G, Lang I, Christ G, Schemper M, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J 

Med 2000;343:611-7

3. Paul W.M. Fedak, Subodh Verma, Tirone E. David, Richard L. Leask, Richard D. Weisel, and Jagdish Butany Clinical and Pathophysiological 
Implications of a Bicuspid Aortic Valve Circulation. 2002;106:900-904