Written by Andrea Fields MHA, RDCS

4 Errors to Avoid when Measuring Aortic Valve Velocity

Evaluating the aortic valve is a routine part of an echocardiogram. There are many methods we use to determine the structure and function of the valve, including 2D, color Doppler and a combination of pulsed & continuous-wave Doppler. With short examination times being a common challenge, it can easily cause measurement errors within our studies. This blog is going to cover 4 errors to avoid when measuring continuous-wave (CW) Doppler tracings of the peak aortic valve velocity.

#1: Not Parallel to Flow

One of the most common errors to properly evaluating the peak aortic valve (AV) velocity, is not having the Doppler cursor parallel to flow. Let’s recall back to the days of learning physics:

  • Velocity, frequency and angle all determine the frequency of sound waves within a moving object
  • Angle between the ultrasound beam and direction of flow should be zero = parallel with blood flow
  • Any angle other than zero, will cause underestimation of the true velocity

Modified Apical 5 Chamber Echo Aortic Valve Doppler

Scanning Tips:

  • Move transducer more lateral on patients body
  • Have patient lean back a small amount
  • Do not use ‘Angle Correction’ feature- likely to cause more error

#2: Measuring Artifact

Avoid measuring fine linear signals at peak velocity waveform. These fine linear signals should not be included in the velocity tracing.

Avoid Linear Signals Aortic Valve Velocity Tracing

Scanning Tips:

  • Decrease Doppler gains to eliminate artifact
  • Decrease Doppler scale for accurate tracings

#3: Measuring Incorrect Velocity Tracing

Mitral regurgitation (MR) velocity can easily be mistaken for the aortic valve (AV) velocity if not paying close attention! We are able to differentiate the two by evaluating the timing at which the velocity occurs.

  • MR velocity will occur during both the isovolumic contraction (IVCT) & relaxation time (IVRT) during systole (moments when both valves are closed before & after systole)
  • AV velocity will occur after IVCT & ends before IVRT during systole (once the aortic valve opens)

Aortic Valve Velocity Timing Measurement

Scanning Tips:

  • Identify valve clicks on Doppler signal
  • Correlate velocity with timing of EKG to identify IVCT & IVRT

Aortic Valve Velocity Valve Clicks

#4: Measuring Post-Extra Systolic Beats

It’s not uncommon for our patients to have PVC’s throughout their exam. Although we cannot prevent this from occurring, we can be sure to not measure these beats! This includes not measuring the extra beat (PVC) and the following velocity jet.

Avoid measuring post-extra systolic beats as peak AV velocity

Scanning Tips:

  • Let the Doppler signal run for a few seconds
  • Only measure signals that are of common velocity strength
  • Patients in A-Fib: measure 5-6 velocities for both AV and LVOT


When evaluating the peak aortic valve CW Doppler velocities, be sure to avoid these 4 common errors:

  1. Doppler Angle Not Parallel to Flow
  2. Measuring Fine Linear Artifact at Peak Velocity
  3. Measuring MR Velocity for Peak AV Velocity
  4. Measuring Extra-Post Systolic Beat Velocities


Andrea Fields MHA, RDCS

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Lang, R. M., MD, Badano, L. P., MD, & Mor-Avi, V., PhD. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JASE, 28(1), 1-53. Retrieved March 1, 2017, from http://asecho.org/wordpress/wp-content/uploads/2015/01/ChamberQuantification2015.pdf

aortaaortic stenosisAortic Valvecardiac chamber quantificationScanning Tips


Debbie Lee
Love your work this a simple explanation and easy to understand. Love this website also. The graphics are beautiful not too busy. Cardioserve found me somehow,and I am glad. I will be spreading the word to our organization and my staff.
This was wonderful article.thanks for it
Gamal Ahmed
Keep the good work...!! Thanks.
catalin mihai
What can I say ? I love enormous topics, simplicity of exposure and argumentation, extremely clear figures and graphics! Without exaggeration, it's the best website on the internet, and believe me I'm an expert in searching the net! The teaching here is worth more than a rough, hard-to-follow echo book . There is also a need for such books, but your simple, straightforward approach should be introduced into the residency curriculum and the echo classes of the major institutions ! Congratulations ! And it's free too! Continue like this! Please, on behalf of those in love with echocardiography at the highest level!
Fantastic, clear and concise explanation. I love CardioServ blog posts. It's always my go to for quick refresher. Well done!
Excellent teaching points and the pictures . Each and every point explained in such concise manner yet full explanation of any topic that you discuss. You area good Teacher . God bless you
Dan Duval
While an "off label" use, contrast agents for left ventricular opacification can be used to enhance the Doppler tracing.
Ahmed Fareed
very good...I like this blog so much....keep the good work

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