Background —Fluid energy loss across stenotic aortic valves is influenced by factors other than the valve effective orifice area (EOA). We propose a new index that will provide a more accurate estimate of this energy loss. Methods and Results —An experimental model was designed to measure EOA and energy loss in 2 fixed stenoses and 7 bioprosthetic valves for different flow rates and 2 different aortic sizes (25 and 38 mm). The results showed that the relationship between EOA and energy loss is influenced by both flow rate and aortic cross-sectional area (A _A ) and that the energy loss is systematically higher (15±2%) in the large aorta. The coefficient (EOA×A _A )/(A _A −EOA) accurately predicted the energy loss in all situations ( r ² =0.98). This coefficient is more closely related to the increase in left ventricular workload than EOA. To account for varying flow rates, the coefficient was indexed for body surface area in a retrospective study of 138 patients with moderate or severe aortic stenosis. The energy loss index measured by Doppler echocardiography was superior to the EOA in predicting the end points, which were defined as death or aortic valve replacement. An energy loss index ≤0.52 cm ² /m ² was the best predictor of adverse outcomes (positive predictive value of 67%). Conclusions —This new energy loss index has the potential to reflect the severity of aortic stenosis better than EOA. Further prospective studies are necessary to establish the relevance of this index in terms of clinical outcomes.

Ultrafast ultrasound is an emerging modality that offers new perspectives and opportunities in medical imaging. Plane wave imaging (PWI) allows one to attain very high frame rates by transmission of planar ultrasound wavefronts. As a plane wave reaches a given scatterer, the latter becomes a secondary source emitting upward spherical waves and creating a diffraction hyperbola in the received RF signals. To produce an image of the scatterers, all the hyperbolas must be migrated back to their apexes. To perform beamforming of plane wave echo RFs and return high-quality images at high frame rates, we propose a new migration method carried out in the frequency-wavenumber (f-k) domain. The f-k migration for PWI has been adapted from the Stolt migration for seismic imaging. This migration technique is based on the exploding reflector model (ERM), which consists in assuming that all the scatterers explode in concert and become acoustic sources. The classical ERM model, however, is not appropriate for PWI. We showed that the ERM can be made suitable for PWI by a spatial transformation of the hyperbolic traces present in the RF data. In vitro experiments were performed to outline the advantages of PWI with Stolt's f-k migration over the conventional delay-and-sum (DAS) approach. The Stolt's f-k migration was also compared with the Fourier-based method developed by J.-Y. Lu. Our findings show that multi-angle compounded f-k migrated images are of quality similar to those obtained with a stateof- the-art dynamic focusing mode. This remained true even with a very small number of steering angles, thus ensuring a highly competitive frame rate. In addition, the new FFT-based f-k migration provides comparable or better contrast-to-noise ratio and lateral resolution than the Lu's and DAS migration schemes. Matlab codes for the Stolt's f-k migration for PWI are provided.