When echo gets in the way: physiological factors affecting Doppler data

SUMMARY: Transthoracic echocardiography (TTE) is widely used as a pre-operative screening tool. It can provide extensive information about cardiac function and underlying pathology, which could influence decisions regarding surgery. This patient was referred for TTE as part of pre-op screening, as he had a biological prosthetic aortic valve. This was a rare case where misleading TTE measurements inadvertently led to the patient being referred for transcatheter aortic valve implantation (TAVI), which delayed non-cardiac surgery. LEARNING POINTS: Echocardiographers and referrers should be familiar with physiological and haemodynamic conditions that can affect measurements. Echocardiographic results should be interpreted in wider clinical context, particularly when it changes management. Lack of clinical information on the referral form limits echocardiographer’s ability to interpret results in clinical context. Referring non-cardiologists may not be aware of haemodynamic factors that could affect echocardiographic measurements.