Aorta, aortic stenosis (AS), aortic regurgitation (AR)

Aortic dimensions using 2D echocardiography Normal interval Normal interval, adjusted Aortic annulus 20-31 mm 12-14 mm/m2 Sinus valsalva 29-45 mm 15-20 mm/m2 Sinotubular junction…

Aortic dimensions using 2D echocardiography


	Normal interval	Normal interval, adjusted
Aortic annulus	20-31 mm	12-14 mm/m2
Sinus valsalva	29-45 mm	15-20 mm/m2
Sinotubular junction	22-36 mm	13-17 mm/m2
Ascending aorta	22-36 mm	13-17 mm/m2
Aortic arch	22-36 mm
Descending aorta	20-30 mm

Adjustment refers to adjusting for body surface area (BSA).

Standardized values for aorta (mean ± SD)


	Aortic annulus	Sinus valsalva
Age	Women	Men	Women	Men
<30	11.4 ± 1.1	11.4 ± 1.2	15.5 ± 1.5	15.3 ± 1.8
30–39	11.7 ± 1.0	11.4 ± 1.1	16.5 ± 1.6	15.7 ± 1.3*
40–49	11.7 ± 1.0	11.5 ± 0.9	16.8 ± 1.4	16.6 ± 1.5
50–59	12.0 ± 0.9	11.5 ± 0.9	17.9 ± 1.6	16.8 ± 1.7*
60–69	11.7 ± 1.1	12.1 ± 1.0	17.5 ± 1.7	17.8 ± 1.6
>70	11.6 ± 1.1	12.0 ± 1.0	18.2 ± 1.9	18.1 ± 1.7
All	11.7 ± 1.0	11.6 ± 1.0	17.0 ± 1.9	16.6 ± 1.8


	Sinotubular junction	Ascending aorta
Age	Women	Men	Women	Men
<30	13.5 ± 1.4	12.7 ± 2.3	15.1 ± 1.6	14.3 ± 1.6*
30–39	14.3 ± 1.5	13.3 ± 1.3	16.4 ± 1.8	14.5 ± 1.4*
40–49	14.6 ± 1.2	14.1 ± 1.5*	16.4 ± 1.4	15.5 ± 1.5*
50–59	15.7 ± 1.3	14.1 ± 1.5	18.0 ± 1.4	16.2 ± 1.6*
60–69	14.7 ± 1.6	15.1 ± 1.6*	17.6 ± 1.7	17.3 ± 1.7
>70	15.5 ± 2.0	14.7 ± 1.6	18.2 ± 3.3	17.5 ± 1.4
All	14.7 ± 1.7	13.9 ± 1.8	16.9 ± 2.3	15.7 ± 1.8


	Aortic arch
Age	Women	Men
<30	10.7 ± 1.0	10.1 ± 1.3*
30–39	11.6 ± 1.6	10.8 ± 1.3*
40–49	11.5 ± 1.2	11.3 ± 1.3
50–59	12.7 ± 1.1	11.3 ± 1.2*
60–69	12.5 ± 1.4	12.0 ± 1.1
>70	12.7 ± 1.2	12.2 ± 1.3
All	11.9 ± 1.5	11.2 ± 1.4

Aortic regurgitation (AR)

Primary parameters


	Mild regurgitation	Moderate regurgitation	Severe regurgitation
Vena contracta (cm)	< 0,3	0,3-0,6	> 0,6
PHT (pressure half time) - CW doppler	> 500	200-500	< 200
Diastolic flow reversal - PW doppler aorta descendens	if present, early diastolic	early diastolic	holodiastolic

Quantification of regurgitant jet


	Mild regurgitation	Moderate regurgitation	Severe regurgitation
Jet-width / LVOT-width	< 0,25	0,25-0,64	> 0,64
Jet-area / LVOT-area	< 0,05	0,05-0,59	> 0,59

Qualitative parameters


	Mild regurgitation	Moderate regurgitation	Severe regurgitation
Jet area	small	variable	large if central, variable if excentric
Coaptation defect	mild	moderate	severe
CW-profile aortic regurgitation	weak	variable	dense
Size left atrium	normal	normal or enlarged	enlarged
Size left ventricle	normal	normal or enlarged	enlarged

Additional PISA-parameters


	Mild regurgitation	Moderate regurgitation	Severe regurgitation
EROA (cm²)	< 0,10	0,10-0,29	> 0,29
Regurgitation volume (ml/beat)	< 30	30-59	> 59
Regurgitation fraction (%)	< 30	30-49	> 49

EROA = (CSA*v)/v(maxMR) {{ flow velocity = CSA*v = 6.28*r2*v(aliasing)

References

1. Zoghbi, William A.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Kraft, Carol D.; Levine, Robert A. et al. (2003): Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 16 (7), pp. 777–802. DOI: 10.1016/S0894-7317(03)00335-3.

2. Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A. et al. (2017): Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 30 (4), pp. 303–371. DOI: 10.1016/j.echo.2017.01.007.

Aortic stenosis (AS)

Disease defining parameters


	Mild stenosis	Moderate stenosis	Severe stenosis
Valve area (cm²)	> 1,5	1,0-1,5	< 1,0
Normalized valve area (cm²/m²)	>0,85	0,6-0,85	< 0,6

Measured parameters


	Aortic sclerosis	Mild stenosis	Moderate stenosis	Severe stenosis
Mean gradient (mmHg)		< 20	20-40	> 40
Peak velocity (m/s)	1,8-2,5	2,6-2,9	3,0-4,0	> 4,0
Peak gradient (mmHg)		< 35	35-65	> 65
Velocity ratio (LVOT / aortic valve)		> 0,5	0,5-0,25	< 0,25

References

1. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P. et al. (2009): Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 22 (1), 1-23; quiz 101-2. DOI: 10.1016/j.echo.2008.11.029.

2. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P. et al. (2009): Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 10 (1), pp. 1–25. DOI: 10.1093/ejechocard/jen303.

3. Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita; Antunes, Manuel J.; Barón-Esquivias, Gonzalo; Baumgartner, Helmut et al. (2012): Guidelines on the management of valvular heart disease (version 2012). In European heart journal 33 (19), pp. 2451–2496. DOI: 10.1093/eurheartj/ehs109.

4. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Edvardsen, Thor; Goldstein, Steven et al. (2017): Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis. A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 30 (4), pp. 372–392. DOI: 10.1016/j.echo.2017.02.009.

Aorta, aortic stenosis (AS), aortic regurgitation (AR)

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