Aortic Stenosis: The Perfect TTE

Expert Advice for Monitoring AS with Echocardiography

The Parasternal Long Axis View

Accurately grading the severity of aortic valve stenosis (AS) is essential for effective patient management, risk assessment, and replacement candidacy. Echocardiography remains the primary tool for evaluating the progression of aortic stenosis, a valvular disease that affects 9 million people worldwide. The prevalence of this pathology has been increasing with the aging population and has degenerative, congenital, or rheumatic etiologies.

In this article, we will discuss expert echocardiographic techniques to improve the transthoracic evaluation of aortic stenosis. The parasternal, apical, right parasternal, and pedoff imaging will be discussed in this comprehensive lesson.

Two Dimensional Imaging

The parasternal long axis view is the first set of images that we acquire during a transthoracic echocardiogram. Global biventricular function, leaflet appearance, and calcific build up can be visually appreciated in this view. The diastolic linear measurement of the interventricular septum, internal left ventricular dimension, and posterior wall should be taken through the mitral leaflet tips. This set of data can confirm the presence of left ventricular hypertrophy and/or cavity dilation prior to the volume assessment in the apical view. Advanced stages of aortic stenosis can lead to congestive heart failure and a drop in ejection fraction may be observed.