Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice

Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M; Pellikka, Patricia A.; Quiñones, Miguel Á.

doi:10.1093/ejechocard/jen303

Cited by 1,177 publications

(1,027 citation statements)

References 101 publications

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“…Doppler echocardiography is the preferred technique for assessing the severity of aortic stenosis. 4 Figure 2 and Table 6 provide a practical stepwise approach for the assessment of aortic stenosis severity. Details can be found in a recent position paper from the European Association of Cardiovascular Imaging.…”

Section: Echocardiographymentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

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Section: Echocardiographymentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

View full text Add to dashboard Cite

“…At the authors' institution, these values are obtained regularly according to practice guidelines proposed by the American Society of Echocardiography. 7 PG m was obtained by integrating a continuous-wave Doppler tracing of flow across the aortic valve. For pre-CPB TEE, either the deep transgastric aortic valve long-axis view or the transgastric long-axis view was used to align the sample volume as parallel to blood flow as possible.…”

Section: Variable Definitions and Echocardiographic Analysismentioning

confidence: 99%

Grading Aortic Stenosis With Mean Gradient and Aortic Valve Area: A Comparison Between Preoperative Transthoracic and Precardiopulmonary Bypass Transesophageal Echocardiography

Whitener

Sivak

Akushevich

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: The authors hypothesized that average precardiopulmonary bypass (pre-CPB) transesophageal echocardiographic (TEE) mean gradient (PG m ) and aortic valve area (AVA) values would be significantly different from preoperative transthoracic (TTE) values in the same patients and that these changes would affect pre-CPB TEE grading of aortic stenosis (AS).Design: Retrospective, observational design. Setting: Single university hospital. Participants: The study comprised 92 patients who underwent aortic valve replacement with or without coronary artery bypass grafting between 2000 and 2012 at Duke University Hospital and who had PG m and AVA values recorded in both pre-CPB TEE and preoperative TTE reporting databases.Interventions: None. Measurements and Main Results: PG m with pre-CPB TEE was lower by 6.6 mmHg (95% confidence interval, -4.0 to -9.3 mmHg; p o 0.001), whereas AVA was higher by 0.10 cm 2 (95% confidence interval, 0.04 to 0.15 cm 2 ; p o 0.001), compared with preoperative TTE values. When using PG m , pre-CPB TEE generated an AS severity 1 grade lower 39.1% of the time and revealed no difference 55.4% of the time compared to preoperative TTE. When using AVA by continuity, pre-CPB TEE generated an AS severity 1 grade lower 14.1% of the time and revealed no difference 81.5% of the time compared to preoperative TTE. When using either PGm or AVA, preoperative TTE exhibited moderate or severe AS for all study patients, whereas, pre-CPB TEE demonstrated mild AS in 5.4% (n ¼ 92) of patients.Conclusions: The authors confirmed their hypothesis that pre-CPB TEE generates different PG m and AVA values compared with preoperative TTE. These differences often underestimate AS severity. Hemodynamic standardizations or adjustments of pre-CPB TEE PG m and AVA values may be necessary in anesthetized patients before assigning an AS grade using these parameters. & 2016 Elsevier Inc. All rights reserved.KEY WORDS: aortic stenosis, aortic valve area, discordance, mean gradient, precardiopulmonary bypass (intraoperative) transesophageal echocardiography P RECARDIOPULMONARY BYPASS (pre-CPB) transesophageal echocardiography (TEE) is essential for intraoperative assessment and surgical guidance during cardiac surgery. Although many patients come to the operating room with an extensive cardiac workup, pre-CPB TEE aortic valve assessment can affect surgical decision-making based on new findings during planned or emergency surgeries. According to a large retrospective review of 3,835 patients undergoing isolated coronary artery bypass grafting (CABG), 3.3% of patients had an unplanned aortic or mitral valve procedure added to the surgery based on pre-CPB TEE findings. 1 Of 1,823 patients undergoing mitral valve surgery, 1.0% of patients underwent an unplanned aortic valve procedure based on incidental findings during pre-CPB TEE. 1 Given that surgical decisions can be based on pre-CPB TEE findings, accurate interpretation of grading parameters during the pre-CPB period is imperative.The validated mean gradient (PG m ) and aor...

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“…Therefore, increases in MVPG during AF with rapid ventricular response may lead to dyspnoea on exertion or left heart decompensation with pulmonary congestion. While the relationship between HR and native MVPG is well known,10 there is currently no evidence about this haemodynamic association after PMVR.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

et al. 2017

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A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was achieved by implantation of a biventricular pacemaker with subsequent His‐bundle ablation because atrial fibrillation was refractory to medical treatment. During biventricular pacing at different rates (50–110 b.p.m.), heart rate correlated positively with both MV mean pressure gradient and global longitudinal strain and negatively with stroke volume. MV pressure gradients directly translated into elevated pulmonary pressures. Thus, rate control and biventricular pacing improved cardiac haemodynamics.

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Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice

Cited by 1,177 publications

References 101 publications

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Grading Aortic Stenosis With Mean Gradient and Aortic Valve Area: A Comparison Between Preoperative Transthoracic and Precardiopulmonary Bypass Transesophageal Echocardiography

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

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