Echocardiographic screening to assess the severity of congenital aortic valve stenosis in children.

Recent reports suggest that peak left ventricular systolic pressure can be estimated from the echocardiogram. This study compares the accuracy of echocardiographic measurements with clinical estimates of severity of aortic stenosis derived from information of the Joint Natural History Study. Twenty-seven children with isolated aortic valve stensosis were evaluated clinically and with echocardiography and cardiac catheterization. From the echocardiograms, the ratio of systolic left ventricular wall thickness to internal dimension (Ws/Ds) showed a better correlation (r = 0.82) with peak left ventricular systolic pressure than did the diastolic ratio. However, there was significant variation so that a precise estimate of peak left ventricular systolic pressure could not be made from the echocardiogram. Eight of the 27 patients had a normal Ws/Ds ratio (0.55 or less), and their cardiac catheterization data revealed mild aortic stenosis not requiring operation. In contrast, clinical criteria based on the Natural History Study identified only three of the patients with mild aortic stenosis. Prospective studies are needed to confirm the usefulness of echocardiography in noninvasive evaluation of children with aortic valve stenosis.