PMC9260961_01
Chest X-ray was acquired in the semi-sitting position and showed bilateral diffuse pulmonary infiltrates consistent with pulmonary edema and bilateral pleural effusion.
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F1
Evaluation by chest X-ray showed bilateral diffuse pulmonary infiltrates consistent with pulmonary edema and bilateral pleural effusion (Figure 1).
Aortic stenosis severity evaluation by Vmax and mean gradient from apical five chambers, right parasternal, and posterior thoracic view where the latter allowed to record the highest Vmax and mean gradient.
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F2
Healthcare) was performed, but it was extremely difficult to obtain good quality images from standard views given the orthopneic decubitus of the patient. However, the aortic valve was heavily calcified, and severe aortic stenosis was documented with a mean gradient of 42 mmHg from the apical 5 chambers view and 35 mmHg from the right parasternal view, with a functional aortic valve area  0.6 cm2 (Figure 2). Mean gradient was recorded definitely higher than that from the standard view at 50 mm Hg (Figure 2).
Multiparametric evaluation of aortic regurgitation severity: (A) Wide color flow regurgitant jet area, (B) PHT 150 ms, (C) PISA radius 8 mm, (D) vena contracta 8 mm, and (E) aortic regurgitation VTI 93 cm and Vmax 3.7 cm/s resulting in an EROA 0.52 cm2 and regurgitant volume 50 ml. PHT: pressure half time; PISA: proximal isovelocity surface area; VTI: velocity time integral; EROA: effective regurgitant orifice area.
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F3
Moreover, aortic regurgitation that appeared mild from the standard view was documented as significant from PTW (Figure 3). In fact, a proper alignment of the aortic regurgitation jet was feasible from this view with a quantification of severity with multiparameter criteria as suggested by the guidelines (pressure half time 150 ms, vena contracta 8 mm, effective regurgitant orifice area 0.5cm2, regurgitant volume 50 ml; Figure 3).