The CardioPhiles

75 year-old man with DOE presented for follow up. He is know to have CAD s/p CABG in 2001 and aortic stenosis. On exam he has a III/VI systolic ejection murmur, mid to late peaking, radiating to the carotid bilaterally. Based on recent echo there is worsening mod-severe low gradient-normal systolic function AS (AVA 0.8 cm2, Mean gradient 29 mmHg with preserved systolic function; in 2010 his AVA was 1.1 and Mean gradient 18 mmHg). His BNP is 155 with normal renal function.

The AVA by 2-D-guided planimetry was 1.5 cm2.

The AVA by 3-D-guided planimetry (measured at the area of maximum stenosis with alignment in 2 orthogonal planes) was 1.0 cm2 and more closely correlated with AVA measured by continuity equation (AVA 0.9 cm2, Mean gradient 30 mmHg, DVI 0.23). This also correlated well with LHC derived mean aortic valve gradient of 29 mmHg. No obstructive CAD by cath. Thus, in this particular case, 3-D TEE-guided planimetry seemed to be more accurately estimate AVA when compared to 2-D TEE-guided planimetry.