THE CONTEXT
Aortic stenosis is evaluated using valve imaging, electrical findings and haemodynamic assessment.
Valve appearance on echocardiography
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Normal aortic leaflets are thin and closed in diastole, with a visible point of coaptation; they open during systole.
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In calcific aortic stenosis, the leaflets are thick and calcified in diastole and barely move during systole.
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Echocardiography may show a calcified valve with restricted opening and a hypertrophied left ventricle.
Electrocardiogram and chest X-ray
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The electrocardiogram may show left ventricular hypertrophy or left bundle branch block.
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The chest X-ray may be normal. A postero-anterior view may show an enlarged left ventricle and dilated ascending aorta, while a lateral view may show valve calcification.
Doppler and cardiac catheterisation
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Doppler assesses stenosis severity and detects associated aortic regurgitation.
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Cardiac catheterisation is mainly used to identify associated coronary artery disease and may also measure the pressure gradient between the left ventricle and aorta.