Flow Characteristics of the SAPIEN Aortic Valve: The Importance of Recognizing In-Stent Flow Acceleration for the Echocardiographic Assessment of Valve Function

The SAPIEN valve demonstrates flow acceleration at two levels, representing contributions of both the stent and valve cusps to the total valve gradient. Failure to recognize this phenomenon may result in inappropriate selection of the in-stent precusp pulsed Doppler spectrum to represent “subvalvular” flow, thereby overestimating the effective orifice area and Doppler velocity index.