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4.2 - Quantification of severity

Author: Jose Juan Gómez de Diego, Alessia Gimelli, Vladyslav Chubuchny, Emilio Pasanisi


 

Quantification of Pulmonary stenosis

Quantitative assessment of pulmonary stenosis severity is based mainly on the transpulmonar pressure gradient1. Calculation of the effective valve area by planimetry is not possible since the required image plane is in general not available. Continuity equation or proximal isovelocity surface area method, although feasible in principle has not been validated in pulmonary stenosis and are rarely performed.

Grading pulmonic stenosis is based on transvalvular gradient pressure. Effective valve area calculation is feasible but is has not been specifically validated in pulmonary stenosis

 

http://www.youtube.com/watch?v=10emkM1K5ew
http://www.youtube.com/watch?v=CJYG_NbGZ5Y
PSAX view of pulmonary valve. Thickened leaflets raises the suspiction of pulmonary stenosis. Colour Doppler view shows flow turbulence on pulmonary flow, the second clue for the diagnosis of pulmonary stenosis.

 

Continous Doppler evaluation of the velocity flow is the main tool in the evaluation of the severity of pulmonary stenosis. In this case the peak velocity of flow is about 1.5 m/s. This not high velocity rules out pulmonary stenosis.

 

http://www.youtube.com/watch?v=7w-W68T1AaQ
http://www.youtube.com/watch?v=Oo6WhJdTBrY
PSAX view of pulmonary valve. Thickened leaflets with restricted movement pattern raises the suspiction of pulmonary stenosis. Colour Doppler view shows marked flow turbulence on pulmonary flow suggesting pulmonary stenosis.

 

Continous Doppler evaluation of the velocity shows a pulmonary flow peak velocity of flow over 4 m/s compatible with severe pulmonary stenosis.

References

  1. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice EJE (2009) Jan; 10(1):1-25.