Skip to main content
SpringerLink
Log in

Valvular Stenosis

  • Chapter
The ESC Textbook of Cardiovascular Imaging

  • 2330 Accesses

Abstract

Echocardiography is the method of choice for the diagnosis, assessment of morphology, and aetiology as well as quantification of valvular stenoses. It permits the additional evaluation of the consequences on atrial and ventricular size and function, myocardium, and pulmonary circulation. haemodynamic assessment can be performed by Doppler echocardiography providing transvalvular gradients as derived from transvalvular velocities with the simplified Bernouilly equation. Depending on the site of disease, valve areas can be determined by the continuity equation, direct planimetry, or empirical formulas. Recently, MR and CT imaging have gained importance in the assessment of valve morphology, ventricular function, and aortic disease. In current practice, their role in quantifying the severity of valve disease, however, remains limited. Imaging techniques are also crucial for the identification of patients suitable for percutaneous interventions and actual guidance of these procedures. It is important to be aware of the specific limitations and pitfalls of the various measurements. Final judgment should be based on an integrated approach involving all available information. Finally, imaging techniques provide prognostic information in valvular stenosis and have a fundamental impact on the decision-making process in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005;111:920–925

    Article  PubMed  Google Scholar 

  2. Rosenhek R, Binder T, Porenta G, et al Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343:611–617

    Article  CAS  PubMed  Google Scholar 

  3. Bonow RO, Carabello BA, Chatterjee K, et al ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48:e1–148

    Article  PubMed  Google Scholar 

  4. Vahanian A, Baumgartner H, Bax J, et al Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–268

    PubMed  Google Scholar 

  5. Baumgartner H, Hung J, Bermejo J, et al Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr. 2009;10:1–25

    Article  PubMed  Google Scholar 

  6. Currie PJ, Seward JB, Reeder GS, et al Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation. 1985;71:1162–1169

    CAS  PubMed  Google Scholar 

  7. Baumgartner H, Stefenelli T, Niederberger J, Schima H, Maurer G. “Overestimation” of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery. J Am Coll Cardiol. 1999;33:1655–1661

    Article  CAS  PubMed  Google Scholar 

  8. Otto CM, Pearlman AS, Comess KA, Reamer RP, Janko CL, Huntsman LL. Determination of the stenotic aortic valve area in adults using Doppler echocardiography. J Am Coll Cardiol. 1986;7: 509–517

    Article  CAS  PubMed  Google Scholar 

  9. Oh JK, Taliercio CP, Holmes DR Jr, 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;11:1227–1234

    Article  CAS  PubMed  Google Scholar 

  10. Monin JL, Quere JP, Monchi M, et al Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108:319–324

    Article  PubMed  Google Scholar 

  11. Schlosser T, Malyar N, Jochims M, et al Quantification of aortic valve stenosis in MRI-comparison of steady-state free precession and fast low-angle shot sequences. Eur Radiol. 2007;17:1284–1290

    Article  PubMed  Google Scholar 

  12. Lembcke A, Thiele H, Lachnitt A, et al Precision of forty slice spiral computed tomography for quantifying aortic valve stenosis: comparison with echocardiography and validation against cardiac catheterization. Invest Radiol. 2008;43:719–728

    Article  PubMed  Google Scholar 

  13. Pouleur AC, le Polain de Waroux JB, Pasquet A, Vanoverschelde JL, Gerber BL. Aortic valve area assessment: multidetector CT compared with cine MR imaging and transthoracic and transesophageal echocardiography. Radiology. 2007;244:745–754

    Article  PubMed  Google Scholar 

  14. Pouleur AC, le Polain de Waroux JB, Kefer J, et al Usefulness of 40-slice multidetector row computed tomography to detect coronary disease in patients prior to cardiac valve surgery. Eur Radiol. 2007;17:3199–207

    Article  PubMed  Google Scholar 

  15. Otto CM, Burwash IG, Legget ME, et al Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997;95: 2262–2270

    CAS  PubMed  Google Scholar 

  16. Rosenhek R, Klaar U, Schemper M, et al Mild and moderate aortic stenosis; natural history and risk stratification by echocardiography. Eur Heart J. 2004;25:199–205

    Article  PubMed  Google Scholar 

  17. Lancellotti P, Lebois F, Simon M, Tombeux C, Chauvel C, Pierard LA. Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis. Circulation. 2005;112:I377–382

    PubMed  Google Scholar 

  18. Vahanian A, Alfieri O, Al-Attar N, et al Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2008;29:1463–1470

    Article  PubMed  Google Scholar 

  19. Wilkins GT, et al Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60: 299–308

    Article  CAS  PubMed  Google Scholar 

  20. Gonzalez MA, Child JS, Krivokapich J. Comparison of two-dimensional and Doppler echocardiography and intracardiac hemodynamics for quantification of mitral stenosis. Am J Cardiol. 1987;60: 327–332

    Article  CAS  PubMed  Google Scholar 

  21. Thomas JD, Weyman AE. Doppler mitral pressure half-time: a clinical tool in search of theoretical justification. J Am Coll Cardiol. 1987;10:923–929

    Article  CAS  PubMed  Google Scholar 

  22. Nishimura RA, et al Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol. 1994;24: 152–158

    Article  CAS  PubMed  Google Scholar 

  23. Nakatani S, et al Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area: comparison of the pressure half-time and the continuity equation methods. Circulation. 1988;77:78–85

    CAS  PubMed  Google Scholar 

  24. Messika-Zeitoun D, et al Sequential assessment of mitral valve area during diastole using colour M-mode flow convergence analysis: new insights into mitral stenosis physiology. Eur Heart J. 2003;24: 1244–1253

    Article  PubMed  Google Scholar 

  25. Izgi C, et al Mitral valve resistance as a determinant of resting and stress pulmonary artery pressure in patients with mitral stenosis: a dobutamine stress study. J Am Soc Echocardiogr. 2007;20: 1160–1166

    Article  PubMed  Google Scholar 

  26. Djavidani B, et al Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol. 2005;45:2048–2053.

    Article  PubMed  Google Scholar 

  27. Palacios IF, et al Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. 2002;105:1465–1471

    Article  PubMed  Google Scholar 

  28. Iung B, et al Late results of percutaneous mitral commissurotomy in a series of 1024 patients. Analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors. Circulation. 1999;99:3272–3278

    CAS  PubMed  Google Scholar 

  29. Fawzy ME, et al Doppler echocardiography in the evaluation of tricuspid stenosis. Eur Heart J. 1989;10:985–990

    CAS  PubMed  Google Scholar 

  30. Lima CO, et al Noninvasive prediction of transvalvular pressure gradient in patients with pulmonary stenosis by quantitative two-dimensional echocardiographic Doppler studies. Circulation. 1983; 67:866–871

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Medical University of Vienna, Vienna, Austria

    Raphael Rosenhek

Authors
  1. Raphael Rosenhek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Mascherbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David C. Maintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helmut Baumgartner
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Hospital Clinico San Carlos, Instituto Cardiovascular, C/Professor Martin Lagos, s/n, 28040, Madrid, Spain

    José Luis Zamorano

  2. Medical Center Dept. Cardiology, Leiden University, Albinusdreef 2, 2333, Leiden, ZA, Netherlands

    Jeroen J. Bax

  3. Dept. Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Frank E. Rademakers

  4. Turku PET Centre, Turku University Hospital, FI-20521, Turku, Finland

    Juhani Knuuti

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited Limited

About this chapter

Cite this chapter

Rosenhek, R., Mascherbauer, J., Maintz, D.C., Baumgartner, H. (2010). Valvular Stenosis. In: Zamorano, J.L., Bax, J.J., Rademakers, F.E., Knuuti, J. (eds) The ESC Textbook of Cardiovascular Imaging. Springer, London. https://doi.org/10.1007/978-1-84882-421-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-421-8_7

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-420-1

  • Online ISBN: 978-1-84882-421-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation