Assessment of Aortic Stenosis From the External Carotid Pulse Wave

The introduction of aortic valve surgery has made the assessment of aortic valve disease in- creasingly 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