IS THE AORTIC VALVE AREA AN EFFECTIVE DIAGNOSTIC PARAMETER OF SEVERE AORTIC VALVE STENOSIS?

Background and Aim: Clinical grading of aortic stenosis (AS) is currently performed non-invasively by Doppler transthoracic echocardiography (TTE) through measurement of aortic peak velocity, mean transaortic pressure gradient, and aortic valve area (AVA). The objective of the study was to evaluate the effective valve area through an intraoperative invasive measurement using various dimensions of Hegar, to evaluate the effective valve area, respecting the valve opening, in the absence of deformation of the valve cusps themselves. Methods: From March 2017 to April 2018, 60 of patients who underwent elective aortic valve replacement for severe aortic stenosis, where also subjected to intraoperative invasive measurement with Hegar. 18 patients (30%) had a bicuspid aortic valve (BAV). All patients underwent preoperative TTE and intraoperative trans-esophageal echocardiogram (TEE). Results: Intraoperative invasive measurement through Hegar showed a total correspondence in aortic valvular area calculated preoperatively by means of TTE and TEE in presence of BAV (P = NS). Instead, in presence of a morphologically tricuspid aortic valve a statistically significant difference (P = 0.001) was highlighted between AVA calculated using non-invasive tests, and invasive measurement by means of Hegar. The last one showed a higher value in comparison with TTE and TEE. Conclusions: AVA is an excellent evaluation parameter in presence of BAV stenosis. Instead, in tricuspid aortic valve stenosis, other parameters should be considered, because preoperative AVA is not the only parameter of certainty for the evaluation of the severity degree of stenosis. The greatest limitation is the small number of sample and consequently a larger study is necessary. © 2018 Italian Federation of Cardiology - I.F.C. All rights reserved