Accurate determination of the transaortic valve gradient using simultaneous left ventricular and femoral artery pressures

Abstract

Accurate determination of the transaortic valve gradient has required two catheters, one in the left ventricle and one in the ascending aorta. We now report a new technique for measurement of the transaortic valve gradient from the simultaneous left ventricular (LV) and femoral artery (FA) pressure tracings. This technique was compared with the "true" gradient obtained by measurement of the simultaneous LV and central aortic pressures, and is accurate (R = 0.999) and relatively simple. Other approaches used to determine the mean transaortic valve gradient were less accurate: simultaneous LV-FA (R = 0.991); aligned LV-FA (R = 0.974); averaged simultaneous and aligned LV-FA (R = 0.981); and nonsimultaneous LV-aorta pullback (R = 0.953). Thus, this new technique provides an accurate transaortic valve gradient without requiring the use of two central catheters.

Simplified method for estimating true aortic valve mean gradient from simultaneous left ventricular and peripheral arterial pressure recordings

“…This is proven by the fact that the gradient relationships in the 6 transeptal cases are the same as those demonstrated in the remaining 20 retrograde cases. Kreuger et al recently reported another method for correcting the distortion inherent in measuring aortic valve gradient by using left ventricular and peripheral (femoral) arterial tracings [6]. Although their data essentially confirm the findings of our original study, they recommended a different technique of correction which eliminates the need for retracing the gradients.…”

Hemodynamic rounds: Transvalvular pressure gradient measurement

“…Minor changes in heart rate make alignment of the central aortic and left ventricular pressures difficult even in normal sinus rhythm. Patients with atrial fibrillation create a very difficult situation for pressure alignment as at least 10 beats or more are necessary to allow for alignment and planimetry [16]. The presence of ectopy will make this type of measurement more unreliable.…”

Calculation of the aortic valve gradient from the left ventricular–femoral and aortic–femoral pairs of pressure waveforms

“…The mean gradient between the LV and the AO is determined by planimetry of the area between the two simultaneously recorded pressure waveforms during the systolic ejection period (SEP) of the LV. The risk and inconvenience associated with the introduction of two central catheters have prompted the development of additional methods for the accurate determination of the transaortic gradient [1][2][3][4][5][6][7].…”