Planimetric assessment of anatomic valve area overestimates effective orifice area in bicuspid aortic stenosis

Erwan Donal, Gian M. Novaro, Dimitri Deserrano, Zoran B. Popovic, Neil L. Greenberg, Kathryn E. Richards, James D. Thomas, Mario J. Garcia*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: Although the continuity equation remains the noninvasive standard, planimetry using transesophageal echocardiography is often used to assess valve area for patients with aortic stenosis (AS). Not uncommonly, however, anatomic valve area (AVAA) obtained by planimetry overestimates continuity-derived effective valve area (AVAE) in bicuspid AS. Methods: Transthoracic Doppler and transesophageal echocardiography were performed to obtain AVAE and AVAA in 31 patients with bicuspid AS (age 61 ± 11 years) and 22 patients with degenerative tricuspid AS (age 71 ± 13 years). Aortic root and left ventricular outflow tract dimensions and the directional angle of the stenotic jet were assessed in all patients. Using these data, a computational fluid dynamics model was constructed to test the effect of these variables in determining the relationship between AVAE and AVAA. Results: For patients with tricuspid AS, the correlation between AVAA (1.15 ± 0.36 cm2) and AVAE (1.13 ± 0.46 cm2) was excellent (r = 0.91, P < .001, Δ = 0.02 ± 0.21 cm2). However, AVAA was significantly larger (1.19 ± 0.35 cm 2) than AVAE (0.89 ± 0.29 cm2) in the bicuspid AS group (r = 0.71, P < .001, Δ = 0.29 ± 0.25 cm 2). Computer simulation demonstrated that the observed discrepancy related to jet eccentricity. Conclusion: For a given anatomic orifice, functional severity tends to be greater in bicuspid AS than in tricuspid AS. This appears to be primarily related to greater jet eccentricity and less pressure recovery.

Original languageEnglish (US)
Pages (from-to)1392-1398
Number of pages7
JournalJournal of the American Society of Echocardiography
Issue number12
StatePublished - Dec 2005

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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