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Invasive Evaluation of Aortic Stenosis

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Aortic Stenosis

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Abstract

In the current valvular guidelines, Doppler Echocardiography is considered the mainstay of diagnosis aortic valve stenosis. Invasive assessment of aortic valve stenosis is reserved in those cases with inconclusive non-invasive studies, discrepant clinical and Doppler findings, and for research purposes prior to TAVR.

In this chapter we will review the different methods of invasive assessment of aortic valve stenosis by both gradient and area measures, the indications, the advantages, and the pitfalls. We will also briefly review the invasive hemodynamics of hypertrophic obstructive cardiomyopathy.

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References

  1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RRA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JM. ACC/AHA guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2014. doi:10.1016/j.jacc.2014.02.536.

    Google Scholar 

  2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines for the management of valvular heart disease. Eur Heart J. 2012;33:2451–96.

    Article  PubMed  Google Scholar 

  3. Kern MJ, Lim M, Goldstein JA. Hemodynamic rounds: interpretation of cardiac pathophysiology from pressure waveform analysis. 3rd ed. New York: Wiley- Blackwell; 2009.

    Google Scholar 

  4. Folland ED, Parisi AF, Carborne C. Is peripheral arterial pressure a satisfactory substitute for ascending aortic pressure when measuring aortic valve gradients? J Am Coll Cardiol. 1984;4(6):1207–12.

    Article  CAS  PubMed  Google Scholar 

  5. Gorlin R, Gorlin SG. Hydraulic formula for calculation of the area of the stenotic mitral valve. other cardiac valves, and central circulatory shunts. Am Heart J. 1951;41:1–29.

    Article  CAS  PubMed  Google Scholar 

  6. Hakki AH, Iskandrian AS, Bemis CE, Kimbiris D, Mintz GS, Segal BL, Brice C. A simplified valve formula for the calculation of stenotic cardiac valve areas. Circulation. 1981;63:1050–5.

    Article  CAS  PubMed  Google Scholar 

  7. Segal J, Lerner D, Miller DC, Mitchell RS, Alderman EA. When should Doppler-determined valve area be better than the Gorlin formula? Variation in hydraulic constants in low flow states. J Am Coll Cardiol. 1987;9(6):1294–305.

    Article  CAS  PubMed  Google Scholar 

  8. Canon SR, Richards KL, Crawford M. Hydraulic estimation of stenotic orifice area: a correction of the Gorlin equation. Circulation. 1985;71:110–78.

    Article  Google Scholar 

  9. Dumesnil JG, Yoanathan AP. Theoretical and practical differences between te Gorlin equation and the continuity equation for calculating aortic and mitral valve areas. Am J Cardiol. 1991;67:1268–72.

    Article  CAS  PubMed  Google Scholar 

  10. Gorlin R. Calculations of cardiac valve stenosis: restoring an old concept for advanced applications. J Am Coll Cardiol. 1987;10(4):920–2.

    Article  CAS  PubMed  Google Scholar 

  11. Carabello BA, Grossman W. Grossman’s cardiac catheteization, angiography, and intervention, 6th ed. Lippincott Williams & Wilkins; 2000.

    Google Scholar 

  12. Carabello BA. Advances in the hemodynamic assessment of stenotic cardiacvalves. J Am Coll Cardiol. 1987;10:912–9.

    Article  CAS  PubMed  Google Scholar 

  13. Burwash JG, Thomas DD, Sadahiro M, Pearlman AS, Verrier ED, Thomas R, Kraft CD, Otto CM. Dependence of gorlin formula and continuity equation valve areas on transvalvular volume flow rate in valvular aortic stenosis. Circulation. 1994;89:827–35.

    Article  CAS  PubMed  Google Scholar 

  14. Abbas AE, Franey LM, Goldstein J, Lester S. Aortic valve stenosis: to the gradient and beyond-the mismatch between area and gradient severity. J Interv Cardiol. 2013;26(2):183–94.

    Article  PubMed  Google Scholar 

  15. Levine RA, Schwammenthal E. Stenosis is in the eye of the observer: impact of pressure recovery on assessing aortic valve area. J Am Coll Cardiol. 2003;41(3):443–5.

    Article  PubMed  Google Scholar 

  16. Schobel WA, Voelker W, Haase KK, Karsch KR. Extent, determinants and clinical importance of pressure recovery in patients with aortic valve stenosis. Eur Heart J. 1999;20(18):1355–63.

    Article  CAS  PubMed  Google Scholar 

  17. Oh JK, Taliercio CP, Holmes Jr DR, et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol. 1988;11:1227–34.

    Article  CAS  PubMed  Google Scholar 

  18. Skjaerpe T, Hegrenaes L, Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimesnional echocardiography. Circulation. 1986;72:810–8.

    Article  Google Scholar 

  19. Garcia D, Pibarot P, Dumesnil JG, Sakr F, Durand LG. Assessment of aortic valve stenosis severity: a new index based on the energy loss concept. Circulation. 2000;101(7):765–71.

    Article  CAS  PubMed  Google Scholar 

  20. Nishimura RA, Grantham A, Connolly HM, et al. Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: the clinical utility of the dobutamine challenge in the catheterization laboratory. Circulation. 2002;106:809–13.

    Article  PubMed  Google Scholar 

  21. Blais C, Burwash IG, Mundigler G, et al. Projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis. Circulation. 2006;113:711–21.

    Article  PubMed  Google Scholar 

  22. Clavel MA, Ennezat PV, Sylvestre M M.D.,†., Dumesnil JG M.D*., Romain C, Zeineb Hachicha Z, Mathieu P, Annaïk Bellouin A, Bergeron S, Meimoun P, Arsenault M, Le Tourneau T, Pasquet A, Couture C, Pibarot P. Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF. J Am Coll Cardiol. 2013;6:175–83.

    Article  Google Scholar 

  23. Eleid M, Nishimura R, Borlaug B, Sorajja P. Acute hemodynamic effects of sodium nitroprusside in low gradient severe aortic stenosis with preserved ejection fraction. J Am Coll Cardiol. 2013;61(10_S). doi:10.1016/S0735-1097(13)62114-2

  24. Khot UN, Novaro GM, Popović ZB, Mills RM, Thomas JD, Murat Tuzcu E, Hammer D, Nissen SE, Francis GS. Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis. N Engl J Med. 2003;348:1756–63.

    Article  CAS  PubMed  Google Scholar 

  25. Carabello BA, Ballard WL, Gazes PC. Patient 65, cardiology pearls. Philadelphia: Hanley and Belfus; 1994. p. 142.

    Google Scholar 

  26. Sinning JM, Hammerstingl C, Vasa-Nicotera M, Adenauer V, lema Cachiguango SJ, Scheer AC, Hausen S, Sedaghat A, Ghanem A, Muller C, Grube E, Nickening G, Werner N. Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcomes in patients after transcatheter aortic valve implantation. J Am Coll Cardiol. 2012;59(13):1134–41.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Beaumont Health, Oakland University/William Beaumont School of Medicine, Royal Oak, MI, USA

    Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI & Ivan Hanson MD

  2. Department of Cardiology/Research Institute, Beaumont Health System, Royal Oak, MI, USA

    Mark C. Pica BS, CCRP

Authors
  1. Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI
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  2. Ivan Hanson MD
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  3. Mark C. Pica BS, CCRP
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Corresponding author

Correspondence to Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI .

Editor information

Editors and Affiliations

  1. Interventional Cardiology Research, Beaumont Health System, Royal Oak, Michigan, USA

    Amr E. Abbas

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© 2015 Springer-Verlag London

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Abbas, A.E., Hanson, I., Pica, M.C. (2015). Invasive Evaluation of Aortic Stenosis. In: Abbas, A. (eds) Aortic Stenosis. Springer, London. https://doi.org/10.1007/978-1-4471-5242-2_5

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  • DOI: https://doi.org/10.1007/978-1-4471-5242-2_5

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5241-5

  • Online ISBN: 978-1-4471-5242-2

  • eBook Packages: MedicineMedicine (R0)

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