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

Aortic dimensions using 2D echocardiography

 Normal intervalNormal interval, adjusted
Aortic annulus20-31 mm12-14 mm/m2
Sinus valsalva29-45 mm15-20 mm/m2
Sinotubular junction22-36 mm13-17 mm/m2
Ascending aorta22-36 mm13-17 mm/m2
Aortic arch22-36 mm 
Descending aorta20-30 mm 

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

Standardized values for aorta (mean ± SD)

 Aortic annulusSinus valsalva
AgeWomenMenWomenMen
<3011.4 ± 1.111.4 ± 1.215.5 ± 1.515.3 ± 1.8
30–3911.7 ± 1.011.4 ± 1.116.5 ± 1.615.7 ± 1.3*
40–4911.7 ± 1.011.5 ± 0.916.8 ± 1.416.6 ± 1.5
50–5912.0 ± 0.911.5 ± 0.917.9 ± 1.616.8 ± 1.7*
60–6911.7 ± 1.112.1 ± 1.017.5 ± 1.717.8 ± 1.6
>7011.6 ± 1.112.0 ± 1.018.2 ± 1.918.1 ± 1.7
All11.7 ± 1.011.6 ± 1.017.0 ± 1.916.6 ± 1.8
 Sinotubular junctionAscending aorta
AgeWomenMenWomenMen
<3013.5 ± 1.412.7 ± 2.315.1 ± 1.614.3 ± 1.6*
30–3914.3 ± 1.513.3 ± 1.316.4 ± 1.814.5 ± 1.4*
40–4914.6 ± 1.214.1 ± 1.5*16.4 ± 1.415.5 ± 1.5*
50–5915.7 ± 1.314.1 ± 1.518.0 ± 1.416.2 ± 1.6*
60–6914.7 ± 1.615.1 ± 1.6*17.6 ± 1.717.3 ± 1.7
>7015.5 ± 2.014.7 ± 1.618.2 ± 3.317.5 ± 1.4
All14.7 ± 1.713.9 ± 1.816.9 ± 2.315.7 ± 1.8
 Aortic arch
AgeWomenMen
<3010.7 ± 1.010.1 ± 1.3*
30–3911.6 ± 1.610.8 ± 1.3*
40–4911.5 ± 1.211.3 ± 1.3
50–5912.7 ± 1.111.3 ± 1.2*
60–6912.5 ± 1.412.0 ± 1.1
>7012.7 ± 1.212.2 ± 1.3
All11.9 ± 1.511.2 ± 1.4

Aortic regurgitation (AR)

Primary parameters

 Mild regurgitationModerate regurgitationSevere regurgitation
Vena contracta (cm)< 0,30,3-0,6> 0,6
PHT (pressure half time) – CW doppler> 500200-500< 200
Diastolic flow reversal – PW doppler aorta descendensif present, early diastolicearly diastolicholodiastolic

Quantification of regurgitant jet

 Mild regurgitationModerate regurgitationSevere regurgitation
Jet-width / LVOT-width< 0,250,25-0,64> 0,64
Jet-area / LVOT-area< 0,050,05-0,59> 0,59

Qualitative parameters

 Mild regurgitationModerate regurgitationSevere regurgitation
Jet areasmallvariablelarge if central, variable if excentric
Coaptation defectmildmoderatesevere
CW-profile aortic regurgitationweakvariabledense
Size left atriumnormalnormal or enlargedenlarged
Size left ventriclenormalnormal or enlargedenlarged

Additional PISA-parameters

 Mild regurgitationModerate regurgitationSevere regurgitation
EROA (cm²)< 0,100,10-0,29> 0,29
Regurgitation volume (ml/beat)< 3030-59> 59
Regurgitation fraction (%)< 3030-49> 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 stenosisModerate stenosisSevere stenosis
Valve area (cm²)> 1,51,0-1,5< 1,0
Normalized valve area (cm²/m²)>0,850,6-0,85< 0,6

Measured parameters

 Aortic sclerosisMild stenosisModerate stenosisSevere stenosis
Mean gradient (mmHg) < 2020-40> 40
Peak velocity (m/s)1,8-2,52,6-2,93,0-4,0> 4,0
Peak gradient (mmHg) < 3535-65> 65
Velocity ratio (LVOT / aortic valve) > 0,50,5-0,25< 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.

Updated on 2025-01-18