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Doppler Assessment of AS - Window Selection — EECC MCQ

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ModerateValvular Heart DiseaseDoppler Assessment of AS - Window SelectionEECC

A 75-year-old woman has echocardiographic findings of a peak aortic velocity of 5.2 m/s, mean gradient 58 mmHg, and AVA 0.6 cm². The echocardiographer notes that the Doppler signal was recorded from the right parasternal window. Why is this window important?

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Correct answer: E — The right parasternal window often provides the most parallel alignment with the aortic jet, capturing the highest velocity and avoiding underestimation of the gradient that occurs with non-parallel Doppler angles

Accurate Doppler assessment of aortic stenosis requires the ultrasound beam to be as parallel as possible to the direction of blood flow through the stenotic valve (angle-dependent measurement). The right parasternal window (patient lying on right side) often provides the best alignment with the aortic jet axis, particularly in elderly patients where the aorta becomes more rightward. Using only the apical 5-chamber view may underestimate the true gradient by 10-30% if the beam-flow angle is suboptimal. The 2025 ESC VHD Guidelines and ASE/EACVI echo guidelines recommend interrogating the aortic valve from multiple windows (apical, right parasternal, suprasternal, subcostal) and reporting the highest velocity obtained.

Reference: ESC/EACTS (2025): VHD Guidelines; ASE/EACVI Echo Guidelines