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LETTER TO THE EDITOR

Ghost-Boostering Phantom Gradients

Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, wcp7{at}email.med.yale.edu

In Response:

Souza implies, erroneously, that adequate preoperative consultation was not obtained and technical deficiencies were present in the echocardiographic examinations. The perioperative management of the patient followed the American College of Cardiology/American Heart Association Practice Guidelines for the Management of Patients with Valvular Heart Disease (1). Two teams of echocardiographers (referring cardiologist and university cardiologists), as well as a cardiovascular radiologist, participated in the care and imaging strategies for this patient. Although a Pedoff transducer is useful, as outlined by Souza, the cardiologists felt the echocardiographic examination met the needs required for decision-making. With regard to the comment concerning the contribution of mitral regurgitation, Figure 2B clearly shows an aortic stenosis Doppler envelope. As a matter of fact postoperatively, with no mitral regurgitation present (s/p mitral valve replacement) the maximal velocity and pressure gradient across the aortic valve was the same. It is uncertain which assumptions Souza made and how he arrived at his approximation of aortic valve area. By use of three different techniques (the continuity equation, planimetry, and cardiac catheterization) the aortic valve area was approximately 1 cm². We felt that this case represents a relatively common problem (differences between echocardiography and cardiac catheterization data) seen when dealing with potential aortic stenosis. We attempted to briefly review this topic and provide some direction to physicians who encounter this situation.

Reference

1. ACC/AHA Practice Guidelines: Guidelines for the management of patients with valvular heart disease. Circulation 1998;98:1949-84.[Free Full Text]

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