Aortic stenosis

Question 1

Valve Hemodynamics

Moderate Aortic Stenosis

Answer 1

• aortic Vmax 3.0–3.9 m/s
• mean gradient 20–39 mm Hg

Question 2

Valve Hemodynamics

Severe Aortic Stenosis

Answer 2

• Aortic Vmax ≥4 m/s
• Mean gradient ≥40 mm Hg
• AVA typically is ≤1.0 cm2 (or AVAi 0.6 cm2/m2)

Question 3

Valve Hemodynamics

Critical Aortic Stenosis

Answer 3

• aortic Vmax ≥5 m/s
• mean gradient ≥60 mm Hg

Question 4

Recommendations for Timing of Intervention of AS

Answer 4

1. In adults with severe high-gradient AS (Stage D1) and symptoms of exertional dyspnea, HF, angina, syncope, or presyncope by history or on exercise testing, AVR is indicated.
2. In asymptomatic patients with severe AS and an LVEF <50% (Stage C2), AVR is indicated.
3. In asymptomatic patients with severe AS (Stage C1) who are undergoing cardiac surgery for other indications, AVR is indicated.
4. In symptomatic patients with low-flow, low-gradient severe AS with reduced LVEF (Stage D2), AVR is recommended.
5. In symptomatic patients with low-flow, low-gradient severe AS with normal LVEF (Stage D3), AVR is recommended if AS is the most likely cause of symptoms.
6. In apparently asymptomatic patients with severe AS (Stage C1) and low surgical risk, AVR is reasonable when an exercise test demonstrates decreased exercise tolerance (normalized for age and sex) or a fall in systolic blood pressure of ≥10 mm Hg from baseline to peak exercise
7. In asymptomatic patients with very severe AS (defined as an aortic velocity of ≥5 m/s) and low surgical risk, AVR is reasonable.
8. In apparently asymptomatic patients with severe AS (Stage C1) and low surgical risk, AVR is reasonable when the serum B-type natriuretic peptide (BNP) level is >3 times normal.
9. In asymptomatic patients with high-gradient severe AS (Stage C1) and low surgical risk, AVR is reasonable when serial testing shows an increase in aortic velocity ≥0.3 m/s per year.
10. In asymptomatic patients with severe high-gradient AS (Stage C1) and a progressive decrease in LVEF on at least 3 serial imaging studies to <60%, AVR may be considered.
11. In patients with moderate AS (Stage B) who are undergoing cardiac surgery for other indications, AVR may be considered.