Extent, determinants and clinical importance of pressure recovery in patients with aortic valve stenosis

Schöbel, Wolfgang A.; Voelker, Wolfram; Haase, Karl K.; Karsch, Karl R.

doi:10.1053/euhj.1998.1479

Cited by 56 publications

(40 citation statements)

References 26 publications

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“…Our findings were in agreement with those of previous investigators (3,10,13), demonstrating that smaller AR dimension along with larger orifice areas increases the chance of reduced pressure gradients. Our results also demonstrate that jet eccentricity also plays an important role, increasing the pressure gradients at the orifice and limiting pressure recovery and therefore increasing functional severity in cases of bicuspid AS.…”

Section: Discussionsupporting

confidence: 93%

“…However, studies (7) have shown that in certain geometric situations (most commonly bileaflet mechanical prostheses), a significant amount of pressure loss is recovered distal to the valve orifice so that the Doppler-derived gradient overestimates the net pressure drop. It has been suggested that pressure recovery in AS depends on the ratio of the valve orifice area and the cross sectional area of the aorta, for this particular ratio determines the extent of flow separation and the formation of vortexes (4,10,13). Several researchers (1,9) have demonstrated that pressure recovery is more prominent in less severe AS, especially when the orifice area is Ͼ0.7 cm 2 .…”

mentioning

confidence: 99%

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Influence of structural geometry on the severity of bicuspid aortic stenosis

Richards

Deserranno

Donal

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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Doppler-derived gradients may overestimate total pressure loss in degenerative and prosthetic aortic valve stenosis (AS) due to unaccounted pressure recovery distal to the orifice. However, in congenitally bicuspid valves, jet eccentricity may result in a higher anatomic-to-effective orifice contraction ratio, resulting in an increased pressure loss at the valve and a reduced pressure recovery distal to the orifice leading to greater functional severity. The objective of our study was to determine the impact of local geometry on the total versus Doppler-derived pressure loss and therefore the assessed severity of the stenosis in bicuspid valves. On the basis of clinically obtained measurements, two- and three-dimensional computer simulations were created with various local geometries by altering the diameters of the left ventricular outflow tract (LVOT; 1.8–3.0 cm), orifice diameter (OD; 0.8–1.6 cm), and aortic root diameter (AR; 3.0–5.4 cm). Jet eccentricity was altered in the models from 0 to 25°. Simulations were performed under steady-flow conditions. Axisymmetric simulations indicate that the overall differences in pressure recovery were minor for variations in LVOT diameter (<3%). However, both OD and AR had a significant impact on pressure recovery (6–20%), with greatest recovery being the larger OD and the smaller recovery being the AR. In addition, three-dimensional data illustrate a greater pressure loss for eccentric jets with the same orifice area, thus increasing functional severity. In conclusion, jet eccentricity results in greater pressure loss in bicuspid valve AS due to reduced effective orifice area. Functional severity may also be enhanced by larger aortic roots, commonly occurring in these patients, leading to reduced pressure recovery. Thus, for the same anatomic orifice area, functional severity is greater in bicuspid than in degenerative tricuspid AS.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Influence of structural geometry on the severity of bicuspid aortic stenosis

Richards

Deserranno

Donal

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…As expected from experimental data (1,2,17) and confirmed in small clinical studies (18 -20), the absolute magnitude of pressure recovery was greater in subjects with higher transvalvular velocities and more severe AS. However, the functional significance of pressure recovery was proportionately larger in patients with a lower degree of stenosis, confirming results in previous experimental and invasive studies (17,19).…”

Section: Discussionsupporting

confidence: 89%

Impact of Pressure Recovery on Echocardiographic Assessment of Asymptomatic Aortic Stenosis: A SEAS Substudy

Bahlmann

Cramariuc

Gerdts

et al. 2010

JACC: Cardiovascular Imaging

111

131

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“…PPM is a condition that occurs when the iEOA of a prosthetic valve is <0.85 cm/m 2 in the presence of elevated gradients across the prosthetic valve [25,26] and is severe at <0.65 cm/m 2 ; in other words, the prosthetic EOA is too small for the patient's BSA and hence his CO (Fig. 9.8).…”

Section: Prosthesis-patient Mismatch (Ppm)mentioning

confidence: 99%

Reverse Area and Gradient Mismatch: The Discordance of a Large Valve Area and High Gradients

Abbas

Lester

2015

Aortic Stenosis

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In previous chapters, we have defined "Area/gradient match" or concordance as present when criteria for AS severity is met by both gradient (∆P) and area variables. Clinical decision making in these cases is rather straightforward and referral for aortic valve replacement, in the appropriate clinical circumstance, is the rule."Area/gradient mismatch" was discussed in detail in the previous chapter and refers to the situations where AS is severe by area but not by gradient criteria. Less commonly, and conversely, an elevated gradient may be present across the aortic valve (AV) in the absence of severe decrease in aortic valve area (AVA); and this has been referred to as "reverse area/gradient mismatch" or discordance. This later form of area/gradient severity discordance has not received as much emphasis in the literature as the former and yet maybe present in both native and prosthetic valves (AV prosthesis ). In these patients, Dopplerderived gradients and areas may not correspond to those obtained invasively, hence creating a "Doppler-catheter mismatch" which may add further challenges in the appropriate determination of the AS severity.Errors of measurements and assumption, alterations in trans aortic valve flow (Q) and pressure recovery (P rec ), and paravalvular obstructions may account for a significant portion of this mismatch phenomenon. P rec may also account for the discrepancy between Doppler-and catheter-derived estimations of AS severity.

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Extent, determinants and clinical importance of pressure recovery in patients with aortic valve stenosis

Cited by 56 publications

References 26 publications

Influence of structural geometry on the severity of bicuspid aortic stenosis

Influence of structural geometry on the severity of bicuspid aortic stenosis

Impact of Pressure Recovery on Echocardiographic Assessment of Asymptomatic Aortic Stenosis: A SEAS Substudy

Reverse Area and Gradient Mismatch: The Discordance of a Large Valve Area and High Gradients

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