Aortic Valve Echocardiograms: Understanding Aortic Gradients & More with Dr. Eric Roselli

The primary tool used to diagnose aortic valve stenosis is an echocardiogram, which shows how well the heart valves are working and measures blood flow through and out of the heart. After an echocardiogram, patients usually get a general overview of the results from their cardiologist. Unfortunately, for many patients, especially with a new diagnosis of aortic stenosis, it can be difficult to understand the echocardiogram’s details and medical terminology and how they factor into the management and treatment of aortic valve disease.

We received a fantastic question from a patient in our community with aortic stenosis who wanted to understand more about her echocardiogram. The question came in from Cora, who asked, “I’ve been told I have moderate aortic stenosis, and I may need surgery in the next five to 10 years. What are the most important findings in an echocardiogram report for aortic valve disease? What about the aortic valve gradient? I want to actively manage and track the disease, but I don’t understand the report.”

We met with Dr. Eric Roselli, Chief of Adult Cardiac Surgery at the Cleveland Clinic in Cleveland, Ohio, to answer Cora’s question. Dr. Roselli has performed over 5,000 cardiac surgeries, including 3,000 heart valve procedures, and specializes in complex aortic valve operations.

Video available online at:

https://www.youtube.com/watch?v=I0fub4--Dww

The Aortic Valve Gradient and What Patients Should Know

Here are the key insights shared by Dr. Roselli:

• An echocardiogram report involves complex information, but the aortic valve gradient is one of the most important parameters. Dr. Roselli said, “There is a lot of information in those reports, and it’s great that patients have access to it through medical charts, but I don’t want Cora to get too caught up on any one value. Although it’s complex, I do think the aortic valve gradient is probably one of the more important parameters to measure.”

• The gradient measures blood flow out of the aortic valve. Dr. Roselli explained that the descriptions and calculations of how narrow the aortic valve opening is in the report are derived from a complex algorithm stored in the echocardiogram machine and depend on several variables, so it’s important to focus on more than just the numbers. “I’m not going to get into the math, but when you throw one variable off a little bit, it can change a complex math equation. It’s all based on the principle of flow. They’re looking at the jet and the velocity of blood flow through the valve. From that, the gradient is the one I like to pay the most attention to because it’s telling me how the blood is flowing through that valve and gives an indirect measure of the blood pressure inside the heart and the aorta.”

• As the pressure rises, the heart works harder. “We want the pressure low and the valves to open freely. As the pressure rises, it means the valve is getting tighter and tighter, the jet is becoming faster and faster, and the heart is working harder and harder,” he explained. “When the heart starts working too hard against a bad valve and gets into the severe range of stenosis, we’re learning it’s better to get it taken care of sooner rather than later, before there is severe damage to the heart. Cora should have a conversation with her doctor about what all those details mean, but shouldn’t get too caught up in the nitty-gritty numbers because sometimes the conditions during the echocardiogram can be off, and a measurement might bounce a little bit, and the numbers won’t be that precise.”

Thanks Dr. Roselli and the Cleveland Clinic!

On behalf of all the patients in our community, thank you, Dr. Eric Roselli, for everything you and your team are doing at the Cleveland Clinic in Cleveland, Ohio!

Related links:

• See Dr. Eric Roselli’s Interactive Surgeon Profile

• Dr. Roselli's Patient Success Story: Ari Mintzer

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Roselli below.