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Optimal use of echocardiography in valvular heart disease evaluation
  1. Robert J Siegel1,
  2. Huai Luo1,
  3. Moody Makar1,
  4. Roy Beigel1,2,3
  1. 1The Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
  2. 2The Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
  3. 3The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Robert J Siegel, Cedars Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA; Robert.siegel{at}cshs.org

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Learning objectives

  • Become familiar with current criteria for defining the severity of valvular disease.

  • Become familiar with the different echocardiographic methods used for heart valve evaluation.

  • Know the strength and limitations of echocardiography for evaluation of valve disease.

Curriculum topic

Non-invasive imaging

Introduction

Patients with valvular heart disease (VHD) can be asymptomatic or present with a wide range of symptoms that may not correlate with the severity of valve dysfunction. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) combining 2D, 3D and Doppler evaluation provide the clinician with valuable and complimentary information on heart valve structure, function and the physiological consequences of the valvular lesion. This non-invasive methodology provides crucial information during the initial clinical evaluation and at follow-up.

Current guidelines recommend TTE as the initial diagnostic test to evaluate patients with known or suspected VHD.1 ,2 While 2D and M-mode TTE can assess valvular motion, morphology and pathology (when present), Doppler provides requisite information on valve haemodynamics, flow velocities across the valve, pressure gradients and calculation of valve area as well as haemodynamic data regarding pulmonary artery pressure and left ventricular (LV) filling parameters. In addition, colour flow Doppler and spectral Doppler provide critical information on valve regurgitation and stenosis severity. Exercise Doppler echocardiography is useful to assess the impact of exercise on valvular and ventricular function as well as the patient's functional capacity. The severity of a valvular lesion is determined using a multiparameter echo Doppler assessment.

Aortic valve pathology

Aortic stenosis

Echocardiography is the imaging modality of choice for diagnosing and estimating the severity of aortic stenosis (AS). The different echocardiographic methods used for evaluation of the aortic valve (AV) for the presence of stenosis are detailed in table 1. TTE is the most well-established imaging modality for evaluating and assessing the severity of AS.1 As shown in figure 1, valve anatomy should …

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