Aortic stenosis in children. Experience with echocardiographic prediction of severity.

Fifty-six children with aortic stenosis were investigated both by echocardiography and cardiac catheterization. The ratio of end-systolic wall thickness (Ws) to internal diameter (LVES) across the minor axis of the LV as determined by echocardiography and multiplied by a factor of 245 predicts left ventricular pressure (r = 0.83). Subtracting the arm systolic blood pressure from the predicted intraventricular systolic pressure (PISP) gives a predicted systolic pressure gradient (r = 0.91). The technique is found to be useful for both initial and sequential noninvasive assessment of aortic stenosis with normal LV function irrespective of the level of obstruction. It is shown to apply equally well to wide range of LV pressures, is independent of volume load, and is useful in predicting small gradients. Some common problems encountered with the measurements are examined in detail.