Table 3.

Indications for Intervention for Valve-Related Abnormalities

Aortic stenosisAVmax ≥4.0 m/s; mean gradient ≥40 mm Hg, AVAi ≤0.6 cm2/m2; SVi <35 mL/m2
Aortic regurgitationDoppler JW ≥65% of LVOT; VC >0.6 cm; Rvol ≥60 mL/beat; RF ≥50%; ERO ≥0.3 cm2; LVESD >50 mm; holodiastolic aortic flow reversal
Mitral stenosisMVA ≤1.5 cm2, T½ ≥150 ms
Mitral regurgitationVC ≥0.7 cm; Rvol ≥60 mL; RF ≥50%; ERO ≥0.40 cm2; LVESV ≥40 mm
Pulmonary stenosisPV velocity >4 m/s, PIG >64 mm Hg
Pulmonary regurgitationColor jet fills RVOT; RVEDVI >150 mm/m2; holodiastolic pulmonary artery reversal
Tricuspid stenosisT½ >190 ms, tricuspid VA <1.0 cm2
Tricuspid regurgitationCentral jet area >10 cm2; VC >0.7 cm; hepatic vein flow reversal
  • Symptomatic patients may be advised intervention with lesser degrees of objective criteria above, when there is multivalvar involvement, depressed left ventricular systolic function, or when valve repair (as opposed to replacement) has high probability of success. These guidelines reflect indications for intervention for acquired heart disease and serve as a reference point for valve-related abnormalities in congenital heart disease. AV indicates aortic valve; AVAi, aortic valve area indexed; EF, ejection fraction; ERO, effective regurgitant orifice; LV, left ventricle; LVESV, left ventricular end-systolic volume; LVOT, left ventricular outflow tract; PV, pulmonary valve; PIG, peak instantaneous gradient; RV, right ventricle; RVEDVI, right ventricular end-diastolic volume indexed to body surface area; Rvol, regurgitant volume; SV, stroke volume; T1/2, diastolic pressure half time; and VC, vena contracta.

  • Reproduced from Nishimura et al13 with permission of the publisher. Copyright ©2014, American Heart Association, Inc, and the American College of Cardiology Foundation.