Low-Flow/Low-Gradient Aortic Stenosis

Awtry, Eric H.; Davidoff, Ravin

doi:10.1161/circulationaha.111.075853

Cited by 51 publications

(29 citation statements)

References 31 publications

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“…[93][94][95] However, it must be noted that these findings are typically from small patient populations, because patients with pseudostenosis are typically not operated on. 96 Dobutamine infusion remains the primary method of distinguishing pseudostenosis from true AS, both with echocardiography and catheterization.…”

Section: Low-flow Low-gradient As With Reduced Efmentioning

confidence: 99%

“…I když je riziko mortality pacientů s pseudostenózou vysoké blížící se při chirurgickém řešení hodnotě 50 % a může pro ně být přínosnější farmakoterapie srdečního selhání na základě důkazů, pacientům se skutečnou AS by více prospěla AVR. [93][94][95] Je však nutno poznamenat, že tyto nálezy jsou typicky získané z malých populací pacientů, protože u pacientů s pseudostenózou se běžně o operaci neuvažuje. 96 Infuze dobutaminu zůstává i nadále hlavní metodou pro rozlišení pseudostenózy od skutečné AS, a to jak echokardiografi cky, tak katetrizačně.…”

Section: Aortální Stenóza S Nízkým Průtokem a Nízkým Gradientem Při Sunclassified

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Accurate Assessment of Aortic Stenosis

et al. 2014

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Section: Low-flow Low-gradient As With Reduced Efmentioning

confidence: 99%

Section: Aortální Stenóza S Nízkým Průtokem a Nízkým Gradientem Při Sunclassified

Accurate Assessment of Aortic Stenosis

et al. 2014

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“…25 The great difficulty of diagnosing this pathology is reflected in the diversity of complementary methods and the different approaches adopted by the working groups that address this issue. (26)(27)(28)(29) In fact, because these patients usually have advanced age and multiple comorbidities, even confirming the hemodynamic data, their evaluation remains complex. 6,14 Figure 1 Example of underestimation of the diameter of the left ventricular outflow tract (LVOT) using 2D echocardiography in a patient with aortic stenosis.…”

Section: Definition and Diagnostic Difficultiesmentioning

confidence: 99%

Paradoxical aortic stenosis: much more than a classification problem

Fj¹

2018

JCCR

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Aortic stenosis (AS) is the most frequent valvular pathology and is one of the most common indications of valve replacement surgery. Its main form of presentation is calcified AS, whose prevalence increases proportionally with age. The indication of aortic valve replacement (AVR) is clear when the echocardiographic parameters of severity are coincident with each other and the patient presents symptoms, deterioration of the left ventricular ejection fraction (LVEF) or other indication of cardiac surgery. But with the advancement of diagnostic methods, new classifications of this condition have emerged. The term "paradoxical low-flow, low-gradient aortic stenosis" appears, which refers to the presence of an aortic valve area (AVA) <1 cm 2 or indexed AVA <0.6 cm 2 /m 2 , associated with low transvalvular flow and gradients, but with preserved LVEF (≥50%). This combination of data leads to a discordant classification (AVA in range of severity, medium gradient with values of mild to moderate disease). Due to the probability of potential errors that could underestimate the AVA by Doppler echo, and the uncertainty about the real meaning of this pathology, it is necessary to confirm the veracity of these findings, to give a correct diagnosis and treatment to patients with this intriguing entity.

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“…A low flow state is defined as an indexed stroke volume < 35 mL/m 2 of the body surface area. A low-flow/low-gradient state can appear in patients with both reduced LVEF due to myocardial systolic dysfunction or preserved LVEF due to small LV cavity size[22]. These 2 conditions will be detailed below.…”

Section: Asmentioning

confidence: 99%

Assessment of aortic valve disease - a clinician oriented review

Mărgulescu

2017

WJC

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Aortic valve disease [aortic stenosis (AS) and aortic regurgitation (AR)] represents an important global health problem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery (either replacement or - in selected cases - aortic valve repair) remains the gold standard of care. To properly identify those patients who are candidates for surgery, the clinician has to carefully assess the severity of valve disease with an understanding of the potential pitfalls involved in these assessments. This review focuses on the practical issues concerning the evaluation of patients with AS and AR from a general cardiologist’s perspective. The most important issues regarding the documentation of the severity of AS and AR are summarized. More specific issues, such as the role of stress echocardiography, other imaging techniques and details regarding the treatment options (medical, surgical, or interventional), are mentioned briefly.

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Low-Flow/Low-Gradient Aortic Stenosis

Cited by 51 publications

References 31 publications

Accurate Assessment of Aortic Stenosis

Accurate Assessment of Aortic Stenosis

Paradoxical aortic stenosis: much more than a classification problem

Assessment of aortic valve disease - a clinician oriented review

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