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Table 3 Native valve follow-up: aortic stenosis and aortic regurgitation*

From: Clinical indications and triaging for adult transthoracic echocardiography: a consensus statement by the British Society of Echocardiography in collaboration with British Heart Valve Society

Aortic stenosis
Mild Moderate Severe
• Vmax: 2.6–2.9 m/s: TTE every 3–5 years
• Cardiologist review if symptomatic
• Vmax: 3.5–3.9 m/s: TTE every 12–18 months
• Vmax: 3.0–3.4 m/s: TTE every 18–24 months
• Valve area: 1.0–1.5cm2
• Cardiologist review
• Vmax: > 4 m/s
• Aortic valve area: < 1 cm2
• TTE every 6 months
• Cardiologist review
TTE alerts for urgent Cardiologist review:
• LVEF < 50% or reduced flow
• Cardiology discussion advised if severe AS and reducing LVEF on sequential TTE’s, LVEF in range of 50–60%
• Rapid progression of Vmax: > 0.3 m/s per year
• Dilated aortic root (≥ 45 mm In Marfans syndrome; ≥ 50 mm in bicuspid aortic valve patients; ≥ 55 mm for all other patients
Other alerts for Cardiologist review advised:
• Development of symptoms: breathlessness, chest pain, pre-syncope, syncope
TTE follow-up for bicuspid aortic valves:
• Bicuspid valve with no stenosis and mild regurgitation: TTE every 3–5 years
• Bicuspid valve with thickening and mild stenosis: TTE every 2 years
Aortic sclerosis:
• Valve thickening and peak velocity ≤ 2.5 m/s: TTE every 5 years (no follow-up usually needed in > 80 years of age unless restricted cusp excursion)
Aortic regurgitation
Mild Moderate Severe
• Mild to moderate: TTE every 3–5 years
• Cardiologist review if aortic root dilated
• TTE every 1–2 years
• Cardiologist review
• TTE every 6–12 months
• Cardiologist review
TTE alerts for urgent Cardiologist review:
• LVEF < 50%
• Cardiology discussion advised if severe AR and reducing LVEF on sequential scans, LVEF in range of 50–60%
• LV systolic dimension approaching 50 mm; LV diastolic diameter approaching 70 mm or severe LV volume dilatation
• Dilated aortic root (≥ 45 mm In Marfans syndrome; ≥ 50 mm in bicuspid aortic valve; ≥ 55 mm for all other patients)
Other alerts: Cardiologist review:
• Development of symptoms
• Trace-mild AR associated with normal aortic valve morphology, normal aortic root and normal ascending aorta does not usually require TTE surveillance
  1. AR (aortic regurgitation), AS (aortic stenosis), cm2 (centimetres squared), LV (left ventricular), LVEF (left ventricular ejection fraction), m/s (meters per second), mm (millimetres), TTE (Transthoracic echocardiography), Vmax (maximum velocity)
  2. *Adapted from Baumgartner et al. 2017 [13] and Chambers et al. 2017 [14]