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Figure 1. Calcific aortic valve stenosis in a 91-year-old female. (A) Parasternal long axis view. The LVOT dimension was measured at 1.9 cm. (B) Parasternal short axis view of the aortic valve in mid systole. (C) Parasternal short axis view of the aortic valve at end diastole. (D) Pulse wave Doppler of the LVOT (V1 = 0.8 cm/s). (E) Continuous wave Doppler across the aortic valve (V2 = 3.8 m/s). (F) Measurement of LVOT in zoom mode where the diameter has been measured from the inner edge to the inner edge of the septum in mid systole (1.8 cm). The mean transaortic valve gradient is 37 mmHg, the peak transaortic valve gradient is 58 mmHg and the calculated aortic valve area is 0.6 cm
2 . LVOT: Left ventricular outflow tract.
(Figure omitted. See article PDF.)
Figure 2. Beat-to-beat variability in Doppler flow velocities in a patient with atrial fibrillation. (A) Pulse wave Doppler flow velocity across the left ventricular outflow tract. (B) Continuous wave Doppler flow velocity across the aortic valve.
(Figure omitted. See article PDF.)
Figure 3. Low-flow, low-gradient severe aortic stenosis with low left ventricular outflow tract. (A & B) Pulse wave (peak velocity = 0.6 m/s) and continuous wave (peak velocity = 3.6 m/s) Doppler across the left ventricular outflow tract (LVOT) and aortic valve (AV), respectively, at baseline in a patient with a left ventricular ejection fraction of 20% and an AV area of 0.5 cm
2 . (C & D) LVOT and AV Doppler velocities (peak velocities of 0.8 and 4.8 m/s, respectively) during 20 μg/kg/min infusion of dobutamine. With dobutamine infusion the AV gradients increased and the aortic valve area remained at 0.5 cm2 thus confirming the presence of severe aortic stenosis. Mean AV gradient increased from 30 mmHg at rest to 51 mmHg at 20 μg/kg/min of dobutamine. Stroke volume increased from 48 ml (heart rate: 56; LVOT diameter: 2.1 cm; velocity time integral: 14 cm) to 86 ml (heart rate: 86; LVOT diameter: 2.3 cm; LVOT velocity time integral: 20.7 cm) in our patient resulting in a contractile reserve of 56%.
(Figure omitted. See article PDF.)
Figure 4. Hypertrophic obstructive cardiomyopathy with dynamic flow obstruction. Echo images of a 30-year-old male with hypertrophic obstructive cardiomyopathy.