Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography.

In 30 patients with aortic stenosis, 14 of whom also had significant aortic regurgitation, the velocities in the stenotic jet (V') and below the valve (V) were recorded by Doppler ultrasound. With two-dimensional echocardiography, two subvalvular areas (A) were calculated from leading-to-leading edge ("large") and trailing-to-leading edge ("inner") diameter measurements. The aortic valve area was calculated by the equation of continuity (A' = A X peak V/peak V') and by calculating stroke volume below the valve [A X integral of V (t) and dividing by the integral of V' (t) (= A"). Based on cardiac output estimations from single-plane angiographic images, Gorlin's formula was used to calculate invasive valve areas. In patients with no or mild aortic regurgitation a second invasive estimate was based on cardiac output measured by the Fick method. The best correlation was found when A' (with "large" diameter) was compared with invasive results based on cardiac output measured by the Fick method (r = .89, SEE +/- 0.12, n = 16); the worst was found when A" (with "large" diameter) was compared with invasive results based on cardiac output measurements by single-plane angiography (r = .80, SEE +/- 0.20, n = 30). The results indicate that valve area in patients with aortic stenosis can be reliably estimated noninvasively, even in those with significant aortic regurgitation.