Aortic valve disease.

AORTIC STENOSIS Clinical suspicion of significant aortic stenosis even in the presence of a normal chest X-ray and electrocardiogram should lead to careful 2-D echocardiographic examination. The lesion can be adjudged mild and the subject probably certificated if the recording shows normal septal and posterior wall thickness, normal left ventricular dimensions and fractional shortening and a valve opening greater than 15 mm. In cases of doubt or where technically satisfactory echocardiograms are unobtainable, cardiac catheterization is likely to be mandatory. For unrestricted certification the peak systolic gradient across the valve should be less than 20 mmHg and the LV end-diastolic pressure less than 12 mmHg at rest, and both must remain within these limits on exercise to three times resting oxygen consumption. AORTIC REGURGITATION Any abnormality of electrocardiogram at rest or on exercise, or of the chest X-ray, any increase in left ventricular dimensions on echocardiography, a diastolic pressure below 65 mmHg and/or pulse pressure greater than 55 mmHg is likely to lead to cardiac catheterization. For full certification any angiographic regurgitation should be trivial.