Research letterThe right parasternal window: when Doppler-beam alignment may be life-saving in patients with aortic valve stenosisBenfari, Giovannia; Mantovani, Francescab; Romero-Brufau, Santiagoc; Setti, Martinaa; Rossi, Andreaa; Ribichini, Flavio L.a; Nistri, Stefanod; Clavel, Marie-AnnickeAuthor Information aSection of Cardiology, University of Verona bAzienda USL- IRCCS di Reggio Emilia, Italy cMayo Clinic, Rochester, Minnesota, USA dCardiology Service, Centro Medico Strumentale Riabilitativo Veneto Medica, Altavilla Vicentina, Italy eInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada Correspondence to Giovanni Benfari, MD, Universita degli Studi di Verona, Verona, Italy E-mail: email@example.com Received 29 December, 2019 Revised 7 February, 2020 Accepted 15 March, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcardiovascularmedicine.com). Journal of Cardiovascular Medicine: October 2020 - Volume 21 - Issue 10 - p 831-834 doi: 10.2459/JCM.0000000000000971 Buy SDC Metrics Abstract The need for multiple transducer positions, especially from right parasternal windows, is consistently mentioned in the recommendations for the accurate measurement of peak velocities across a stenotic aortic valve, but yet poorly adopted. We performed a subanalysis of the largest prospective series on the right parasternal acoustic windows in patients with aortic stenosis (330 consecutive) to calculate the degree of misalignment and estimate the potential outcome implication of this often-forgotten approach. The right parasternal view was highly feasible with an average estimated misalignment from the apical view of 14 ± 16 degree; in 10 cases, an estimated misalignment >40 degree. Right parasternal assessment (vs. apical alone) provided a significant reclassification from moderate to severe or even very-severe aortic valve stenosis. Considering a wellestablished survival benefit provided by either percutaneous or surgical valve replacement in patients with severe aortic stenosis the reclassification would result in approximately 1 life-year saved for every 30–35 patients in whom parasternal view were effectively utilized. © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.