Pressure recovery in aortic stenosis
Pressure recovery explains why Doppler gradients can exceed catheter gradients across the same valve. It matters mainly with a small ascending aorta (< 30 mm) and can cause Doppler to overestimate stenosis severity.
Clinically reviewed 15 July 2026 · EchoRapp clinical content
Simple approach
Treat a Doppler gradient that is higher than the catheter gradient as expected physics, not error. Doppler reports the pressure drop at the vena contracta before any pressure is recovered; the catheter reports the net drop after recovery. The difference is the recovered pressure.
Measure the ascending aorta on every aortic stenosis study. If it is smaller than about 30 mm, be aware that the Doppler gradient may overestimate severity, and lean on valve area, velocity ratio, and — where recovery is likely — the energy loss index.
| Situation | What to do |
|---|---|
| Ascending aorta ≥ 30 mm | Recovery is usually small; the Doppler gradient can be used as is |
| Ascending aorta < 30 mm | Consider overestimation; cross-check area, velocity ratio, energy loss index |
| Bicuspid or congenital AS | Recovery is often relevant; a smaller, non-dilated aorta is common |
| Bileaflet mechanical valve | Expect pronounced recovery and falsely high Doppler prosthetic gradients |
Info
Pressure recovery does not change the true haemodynamic burden — it only changes which number you read. The net gradient and a recovery-corrected area describe the physiologically relevant load on the ventricle.
Detailed tutorial
Work through the interactive tutorial below. Adjust jet velocity, effective orifice area, and ascending-aorta diameter to watch the Doppler gradient split into recovered pressure and the net, catheter-equivalent gradient. It walks through the underlying energy physics, the settings where recovery matters most (small aorta, congenital and bicuspid AS, children and small adults, bileaflet mechanical valves), and the recovery-corrected indices — the energy loss index and the velocity ratio.
For demonstration purposes only. This simulation is not intended for clinical use and must not be used on patients. MediRapp assumes no liability for its use in a clinical setting.
References
- Helmut Baumgartner et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 2009;10(1):1–25. View guideline
- Fabien Praz et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2025;46(44):4635–4736. View guideline