What is the limitation of Doppler echocardiography for the diagnosis of aortic stenosis (AS)?

Updated: May 07, 2019
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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The major limitation of Doppler echocardiography in assessing the severity of aortic stenosis is underestimation of the gradient if the sound beam is not parallel to the aortic stenosis velocity jet. Thus, in a patient with clinical features of severe aortic stenosis but echo/Doppler findings of mild to moderate aortic stenosis, further evaluation with repeat Doppler or cardiac catheterization may be required.

Rarely, Doppler may overestimate the severity of aortic stenosis in patients with severe anemia (hemoglobin < 8 g/dL), a small aortic root, or sequential stenoses in parallel (coexistent LV outflow tract [LVOT] and valvular obstruction).

Furthermore, echocardiographic calculation of AVA is highly dependent on accurate measurement of the diameter of the LVOT. In patients with poor transthoracic echocardiographic images, TEE may be used to measure the mean and peak gradient and a planimeter may be used to assess the AVA.

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