Aortic Valve Area by Velocity Ratio

How to get an AVA by Velocity Ratio.

1. Measure the LVOT diameter in centimeters. The optimal view is a maximally zoomed view of the midesophageal AVLAX. The gain and compress should be set so the endomyocardial wall of the LVOT is clearly discernable. Freeze the display and use the trackball to cycle thru the cardiac cycle to the mid-ejection period when the LVOT is at it's maximal diameter. Using the calipers, measure from intimal wall to intimal wall just proximal to the aortic valve. Activate the Aortic Valve analysis package and select LVOT diameter and enter the value of the LVOT diameter.
2. Obtain a continuous wave doppler of the aortic valve. The optimal view is the deep transgastric AVLAX view or the transgastric AVLAX view. The former view is preferable if obtainable. Once the view is obtained turn on the CWD and use the track ball to move the CWD line to the aortic valve. A doppler profile of the aortic valve should be displayed with high velocities in aortic stenosis. If a poor or low velocity doppler wave form is displayed reposition the view and move the CWD line thru out the valve. The CWD must be parallel to the stenotic jet to pick up the maximal velocity and obtain a good doppler wave form. After a good doppler wave form is obtained look at the morphology of the waveform and note it. Valvular aortic stenosis has a uniform increase and decrease in the velocity profile. Aortic Stenosis from IHSS has a dagger shaped velocity profile. Using the tracing feature, use the trackball and trace the doppler profile. The maximum velocity, Vmax, for the AV should be enter above.
3. Obtain a pulse wave doppler of the LVOT. The optimal view is the deep transgastric AVLAX view or the transgastric AVLAX view. The former view is preferable if obtainable. Once the view is obtained turn on the PWD and use the track ball to move the PWD line to the LVOT and place the sample volume just proximal to the aortic valve. The sample volume should be at the same location where the LVOT diameter was measured. A doppler profile of the LVOT should be displayed with normal velocities in the LVOT. If a poor or low velocity doppler wave form is displayed reposition the view and move the PWD line thru out the LVOT. The PWD must be parallel to the LVOT jet to pick up the maximal velocity and obtain a good doppler wave form. After a good doppler wave form is obtained look at the morphology and the maximal velocity of the waveform and note it. Using the tracing feature, use the trackball and trace the doppler profile. The maximum velocity, Vmax, for the LVOT should be entered above.

   (Optional): If you cannot obtain a good PWD profile of the LVOT the CWD profile of the Aortic Valve frequently will exhibit a ghost profile which is contained in the CWD profile. This ghost profile can be traced as if it was a PWD profile and entered as the Vmax of the LVOT.