In combined aortic stenosis and insufficiency, the continuous-wave aortic waveform must be carefully analyzed so that the severity of the aortic stenosis will be correctly assessed. A mild gradient may be expected if:
a.) A high peak velocity is recorded with an early-peaking, asymmetrical, rapidly descending spectrum.
b.) A high peak velocity is recorded with a later-peaking, symmetrical spectrum.
c.) A low peak velocity is recorded with a late-peakin, symmetrical waveform.
d.) a low peak velocity is recorded with early- peaking, asymmetrical waveform.
a,) and d.) The Doppler aortic spectral waveform in significant aortic stenosis is late-peaking and symmetrical. If the aortic stenosis is less severe, the spectral waveform shows early peaking and a rapid descent, becoming asymmetrical. This is important in cases of combined aortic stensosis and insufficiency and also in cases of poor left ventricular function.