Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve

Aortic stenosis (AS) causes left ventricular outflow obstruction. Severe AS has major haemodynamic implications in critically ill patients, in whom increased cardiac output and oxygen delivery are often required. Transthoracic echocardiography (TTE) plays a key role in the AS severity grading. In...

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Main Authors: Jeroen Walpot, Guy L. Vermeiren, Amar Al Mafragi, Manu L.N.G. Malbrain
Format: Article
Language:English
Published: Termedia Publishing House 2021-03-01
Series:Anaesthesiology Intensive Therapy
Subjects:
Online Access:https://www.termedia.pl/Comprehensive-assessment-of-the-aortic-valve-in-critically-ill-patients-for-the-non-cardiologist-Part-I-Aortic-stenosis-of-the-native-valve,118,43538,1,1.html
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author Jeroen Walpot
Guy L. Vermeiren
Amar Al Mafragi
Manu L.N.G. Malbrain
author_facet Jeroen Walpot
Guy L. Vermeiren
Amar Al Mafragi
Manu L.N.G. Malbrain
author_sort Jeroen Walpot
collection DOAJ
description Aortic stenosis (AS) causes left ventricular outflow obstruction. Severe AS has major haemodynamic implications in critically ill patients, in whom increased cardiac output and oxygen delivery are often required. Transthoracic echocardiography (TTE) plays a key role in the AS severity grading. In this review, we will give an overview of how to use the simplified Bernoulli equation to convert the echo Doppler measured velocities (cm s-1) to AS peak and mean gra­dient (mm Hg) and how to calculate the aortic valve area (AVA), using the continuity equation, based on the principle of preservation of flow. TTE allows quantification of compensatory left ventricular (LV) hypertrophy, assessment of LV systolic function, and determination of LV diastolic function and LV loading. Subsequently, the obtained results from the TTE study need to be integrated to establish the AS severity grading. The pitfalls of echocardiographic AS severity assessment are explained, and how to deal with inconsistency between AVA and mean gradient. The contribution of transoesophageal echocardiography, low-dose dobutamine stress echo (in case of low-flow low-gradient AS), echocardiography strain imaging, cardiac magnetic resonance imaging, cardiac multidetector computed tomography and the relatively new concept of Flow Pressure Gradient Classification to the work-up for aortic stenosis is discussed. Finally, the treatment of AS is overviewed. Elective aortic valve replacement is indicated in patients with severe symptomatic AS. In the ICU, afterload reduction by vasodilator therapy and treatment of pulmonary and venous congestion by diuretics could be considered.
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spelling doaj.art-ff0c3969f608452da1aa623624aea5af2022-12-21T18:20:48ZengTermedia Publishing HouseAnaesthesiology Intensive Therapy1642-57581731-25312021-03-01531375410.5114/ait.2021.10455043538Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valveJeroen WalpotGuy L. VermeirenAmar Al MafragiManu L.N.G. MalbrainAortic stenosis (AS) causes left ventricular outflow obstruction. Severe AS has major haemodynamic implications in critically ill patients, in whom increased cardiac output and oxygen delivery are often required. Transthoracic echocardiography (TTE) plays a key role in the AS severity grading. In this review, we will give an overview of how to use the simplified Bernoulli equation to convert the echo Doppler measured velocities (cm s-1) to AS peak and mean gra­dient (mm Hg) and how to calculate the aortic valve area (AVA), using the continuity equation, based on the principle of preservation of flow. TTE allows quantification of compensatory left ventricular (LV) hypertrophy, assessment of LV systolic function, and determination of LV diastolic function and LV loading. Subsequently, the obtained results from the TTE study need to be integrated to establish the AS severity grading. The pitfalls of echocardiographic AS severity assessment are explained, and how to deal with inconsistency between AVA and mean gradient. The contribution of transoesophageal echocardiography, low-dose dobutamine stress echo (in case of low-flow low-gradient AS), echocardiography strain imaging, cardiac magnetic resonance imaging, cardiac multidetector computed tomography and the relatively new concept of Flow Pressure Gradient Classification to the work-up for aortic stenosis is discussed. Finally, the treatment of AS is overviewed. Elective aortic valve replacement is indicated in patients with severe symptomatic AS. In the ICU, afterload reduction by vasodilator therapy and treatment of pulmonary and venous congestion by diuretics could be considered.https://www.termedia.pl/Comprehensive-assessment-of-the-aortic-valve-in-critically-ill-patients-for-the-non-cardiologist-Part-I-Aortic-stenosis-of-the-native-valve,118,43538,1,1.htmlaortic stenosis transthoracic echocardiography transoesophageal echocardiography multidetector computed tomography cardiac magnetic resonance (cmr) aortic valve area transvalvular gradient continuity equation global longitudinal strain (gls) treatment of aortic stenosis.
spellingShingle Jeroen Walpot
Guy L. Vermeiren
Amar Al Mafragi
Manu L.N.G. Malbrain
Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
Anaesthesiology Intensive Therapy
aortic stenosis
transthoracic echocardiography
transoesophageal echocardiography
multidetector computed tomography
cardiac magnetic resonance (cmr)
aortic valve area
transvalvular gradient
continuity equation
global longitudinal strain (gls)
treatment of aortic stenosis.
title Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
title_full Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
title_fullStr Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
title_full_unstemmed Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
title_short Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve
title_sort comprehensive assessment of the aortic valve in critically ill patients for the non cardiologist part i aortic stenosis of the native valve
topic aortic stenosis
transthoracic echocardiography
transoesophageal echocardiography
multidetector computed tomography
cardiac magnetic resonance (cmr)
aortic valve area
transvalvular gradient
continuity equation
global longitudinal strain (gls)
treatment of aortic stenosis.
url https://www.termedia.pl/Comprehensive-assessment-of-the-aortic-valve-in-critically-ill-patients-for-the-non-cardiologist-Part-I-Aortic-stenosis-of-the-native-valve,118,43538,1,1.html
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