{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:35Z","timestamp":1753876295307,"version":"3.41.2"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T00:00:00Z","timestamp":1726272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Aortic stenosis (AS) is the most commonly acquired valvular pathology in the western world. Aortic stenosis severity is typically evaluated with Doppler echocardiography. Evaluation of aortic gradients using standard Doppler echocardiography from the apical window may underestimate the true gradient due to misalignment of blood flow to the ultrasound beam and is often better evaluated from other imaging windows using a non-imaging continuous wave Doppler (NI-CWD) probe. Herein, we describe a unique case of AS being underestimated by dynamic acoustic shadowing from the apical window rather than beam misalignment.<\/jats:p>\n <\/jats:sec>\n \n Case summary<\/jats:title>\n The patient is a Hispanic 31-year-old male with a congenital bicuspid aortic valve who underwent a balloon aortic valvuloplasty at age 13. At age 31, the patient underwent a repeat transthoracic echocardiogram (TTE) that was largely unchanged from his prior TTE from 15 years prior. Notably on this TTE, there was acoustic shadowing of colour Doppler in the distal left ventricular outflow tract and aortic valve during systole. While gradients only suggested moderate AS, the degree of left ventricular hypertrophy was suspicious for more severe AS. Only by using the NI-CWD probe at the right sternal border were we able to identify very severe AS with a peak velocity of 6.5\u2005m\/s and a mean gradient of 100\u2005mmHg.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n In our specific case, dynamic acoustic shadowing of the aortic valve from the apical window obscured both imaging and Doppler signals. This acoustic shadowing was not present from the right sternal border with the NI-CWD probe, leading to an over 100% increase in aortic valve peak velocity and proper correction of AS severity. This allowed for expedited care and underscores the importance of such techniques.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae501","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T05:23:31Z","timestamp":1726205011000},"source":"Crossref","is-referenced-by-count":0,"title":["A case report of critical aortic stenosis diagnosed utilizing non-imaging continuous wave Doppler probe"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3380-9375","authenticated-orcid":false,"given":"Edward D","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Medicine, Kaiser Permanente Oakland Medical Center , 3701 Broadway, 4th Floor, Oakland, CA 94611 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kaiser Permanente Oakland Medical Center , 3701 Broadway, 4th Floor, Oakland, CA 94611 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,9,14]]},"reference":[{"key":"2024103011424743800_ytae501-B1","doi-asserted-by":"crossref","first-page":"811310","DOI":"10.3389\/fcvm.2021.811310","article-title":"Editorial: comorbidities and aortic valve stenosis: molecular mechanism, risk factors and novel therapeutic options.","volume":"8","author":"St. Hilaire","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2024103011424743800_ytae501-B2","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.jacc.2013.05.015","article-title":"Aortic stenosis in the elderly.","volume":"62","author":"Osnabrugge Ruben","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2024103011424743800_ytae501-B3","doi-asserted-by":"crossref","first-page":"G19","DOI":"10.1530\/ERP-20-0035","article-title":"Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography","volume":"8","author":"Ring","year":"2021","journal-title":"Echo Res Pract"},{"key":"2024103011424743800_ytae501-B4","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1001\/jamacardio.2018.3152","article-title":"Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics.","volume":"3","author":"Lancellotti","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2024103011424743800_ytae501-B5","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2024103011424743800_ytae501-B6","first-page":"e523","article-title":"2008 focused update incorporated into the ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons","volume":"118","author":"Bonow","year":"2008","journal-title":"Circulation"},{"key":"2024103011424743800_ytae501-B7","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.echo.2015.02.016","article-title":"Doppler imaging in aortic stenosis: the importance of the nonapical imaging windows to determine severity in a contemporary cohort.","volume":"28","author":"Thaden","year":"2015","journal-title":"J Am Soc Echocardiogr"}],"container-title":["European Heart Journal - 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