Doppler Echocardiographic Quantification of Stenotic Valvular Lesions

Abstract

SummaryThe individual performing quantitative measurements of valve stenosis must always be vigilant of the most common errors made in assessing stenotic lesions:1. Underestimation of pressure gradients across stenotic valves can lead to false‐negative diagnoses. A Doppler angle greater than 25 degrees or the failure to insonate the high‐velocity region are common causes.2. Over‐ and underestimation of pressure gradients is possible when angle correction is used.3. Mistaken sample volume position (such as detection of high‐velocity mitral regurgitation when assessing aortic stenosis) can lead to overestimation of stenotic pressure gradients.4. Improper instrument settings can lead to inaccurate velocity measurements.We have entered an area in which Doppler and imaging echocardiography are capable of producing accurate hemodynamic data on patients with stenotic valve lesions. Such data can be used to make surgical decisions or to avoid further, sometimes more definitive, diagnostic tests. We must use care to assure that the measurements that we report are appropriate and accurate. It is appropriate to integrate the Doppler and imaging echocardiographic data with information obtained from history, physical exam, ECG, and chest roentgenogram to provide the most accurate assessment of the severity of the valve lesion(s). It is also important to interpret the quality of a study and report the likelihood that the study is complete and the results are highly accurate or that the study was difficult and may be incomplete.