Assessment of Aortic Stenosis from the External Carotid Pulse Wave.

The introduction of aortic valve surgery has made the assessment of aortic valve disease increasingly important, and attention has been focused on the arterial pulse as an aid to diagnosis. Experimental studies on aortic stenosis were carried out by De Heer in 1912 and later by Allan (1925) and by Katz, Ralli, and Cheer (1928), who showed that an increasing systolic pressure gradient across the aortic valve occurred proportional to the degree of obstruction, and that there was an associated alteration of the pulse wave on the distal side of the stenosis. Katz and Feil (1925) showed that alterations in the indirect subclavian pulse consisted chiefly of prolongation of the ejection time and an anacrotic appearance in patients with aortic stenosis. Studies of the direct arterial pressure pulse, usually from the brachial artery, have been carried out in recent years and have proved disappointing in assessing the severity of the aortic stenosis, largely because of the overlap between the normal and the abnormal (Goldberg, Bakst, and Bailey, 1954; Gorlin and Case, 1956; Fleming and Gibson, 1957; Hancock and Abelmann, 1957; Wood, 1958; Robinson, 1963). Attempts have also been made to assess the degree of aortic stenosis from the indirect carotid pulse wave (Duchosal et al., 1956; Donoso et al., 1956; Eggink, Hartog, and Kuipers, 1958; Daoud, Reppert, and Butterworth, 1959; Benchimol, Dimond, and Shen, 1960; Robinson 1963), and it is probable that this wave form reflects central events more clearly than the direct brachial arterial pulse. In the majority of these papers an objective assessment of the degree of aortic stenosis was not available, although the diagnosis of aortic stenosis could frequently be made from an analysis of the carotid pulse. The main purpose of this paper is an attempt to determine whether the presence and the degree of aortic stenosis can be assessed from an externally recorded carotid pulse wave. The carotid pulse has been recorded and analysed in a group of patients with aortic stenosis where an objective assessment of the severity of the obstruction was available.