Ultrasound examinations:
(1) M-mode echocardiography
(2) 2-dimensional echocardiography
(3) Doppler ultrasonography
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Aortic Valve Stenosis
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Features
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congenital
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2 cusps identified during systole; systolic cup doming or highly asymmetric thickening or both
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rheumatic
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commissural fusion with mitral valve stenosis
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degenerative
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thickening and increased echogenicity of the cusps (excluding the free edges) with reduced systolic opening
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Aortic Valvular Calcifications on Echocardiography
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Degree
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Grade
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none or minimal
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none
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1
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small isolated spots (mild)
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mild
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2
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multiple, large spots (moderate)
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moderate
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3
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extensive thickening and calcification of the cusps
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severe
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4
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Mitral annular calcifications defined as dense, highly reflective area at the base of the mitral valve leaflet.
increase in aortic-jet velocity in m/sec =
= ((aortic jet velocity in m/sec at first exam) – (aortic jet velocity in m/sec at second exam)) / (time in years between examinations)
where:
• The examinations are >= 6 months apart.
Risk factors for poor prognosis in patients with asymptomatic aortic stenosis:
(1) presence of moderate or severe valvular calcifications
(2) increase in mean aortic-jet velocity (>= 0.3 m per second per year)
Factors not found to be independent predictors:
(1) age
(2) sex
(3) coronary artery disease
(4) hypertension
(5) diabetes mellitus
(6) hypercholesterolemia
