Which of the following Doppler modalities are most appropriate to calculate the maximal jet velocity through a stenotic aortic valve? A. Continuous wave Doppler B. Color flow Doppler C. Pulsed wave Doppler D. Power Doppler
A. Continuous wave Doppler Explanation: the high velocities present in an outflow tract upstream of a stenotic valve will exceed the Nyquist limit of pulsed wave Doppler and aliasing will occur, rendering the results uninterpretable. Color flow will demonstrate aliasing (turbulence) and is useful for directionality, but will not provide any further information regarding velocity. Power Doppler is primarily appropriate in low-velocity flow settings.
Apical 5-chamber view: diffusely echogenic and distorted aortic valvular apparatus apparent. Visible interventricular septum hypertrophied with preserved thickening and inward excursion (within the limits of this view).
Color flow Doppler demonstrates aliasing throughout left ventricular outflow tract, area of flow convergence extends through most of visible left ventricle.
Continuous wave Doppler gate directed through outflow tract based on color flow profile; peak velocity (red arrow) 5.4 m/s
Parasternal long axis zoomed to aortic valve, notable for severe calcification of right coronary cusp, noncoronary cusp out of plane. No dilation of aortic root, no flaps within lumen.
Impression: thickened, echogenic aortic valve cusps with restricted mobility and distortion of the valvular apparatus, suspicious for senile calcific aortic valve stenosis.