Valvular stenosis
Evaluation of valve stenosis in the critical care setting can be challenging, as the clinical status of the patient may preclude the gold standard for assessment (multimodality imaging), demanding reliance on echocardiographic parameters that are not well-validated in the intensive care unit. Valve stenosis is common, and where it precipitates intensive care admission is likely to be severe, and affecting the left-sided valves. On occasion, however, stenosis may be an incidental finding in a critically ill patient with a variable impact on their clinical status. Right-sided lesions are rare (outside the grown-up congenital patient population) and only very infrequently lead to acute haemodynamic deterioration. Echocardiography is indicated in any intensive care unit (ICU) patient where there is suspicion of valvular heart disease. This chapter outlines how to assess valvular stenosis and define its severity in the critical care setting according to integrated echocardiographic parameters. It highlights how critical care pathophysiology may complicate this evaluation, and any potential pitfalls that may exist.