Aortic Stenosis

Question 1

What is the AVA for mild aortic stenosis

Answer 1

1.6-2.5 cm2

Question 2

What is the AVA for moderate aortic stenosis

Answer 2

1.1-1.5 cm2

Question 3

What is the AVA for severe aortic stenosis

Answer 3

<1 cm2

Question 4

What is the mean gradient for mild aortic

Answer 4

<20 (mmHg)

Question 5

What is the mean gradient for moderate aortic stenosis

Answer 5

20-39 (mmHg)

Question 6

What is the mean gradient for severe aortic stenosis

Answer 6

> 40 (mmHg)

Question 7

What is the peak velocity for mild aortic stenosis

Answer 7

2.0-2.9 (m/s)

Question 8

What is the peak velocity for moderate aortic stenosis

Answer 8

3.0-3.9 (m/s)

Question 9

What is the peak velocity for severe aortic stenosis

Answer 9

> 4

Question 10

What are the values measured for aortic stenosis grading

Answer 10

Aortic valve area, mean gradient, peak velocity

Question 11

Stage A aortic stenosis

Answer 11

At risk of AS (bicuspid or sclerotic valve with normal hemodynamics)

Question 12

Stage B aortic stenosis

Answer 12

Progressive AS (mild-mod AS with normal LVEF, possible early diastolic dysfunction)

Question 13

Stage C aortic stenosis

Answer 13

C1- asymptomatic severe AS mean gradient >40 mmHg
C2- asymptomatic severe AS-with LV dysfunction

Question 14

Stage D aortic stenosis

Answer 14

D1- High gradient AS
D2- severe low-flow/low-gradient reduced LVEF
D3-severe low gradient AS normal LVEF or paradoxical low-flow AS

Question 15

Class 1 Indication for AVR

Answer 15

symptomatic severe high gradient AS (D1)

Question 16

Class 1b Indication for AVR

Answer 16

AVR indicated for asymptomatic severe AS with LVEF <50% (Stage C2)

Question 17

What is the AVA for mild aortic stenosis

Answer 17

> 1.5

Question 18

What is the AVA for moderate aortic stenosis

Answer 18

1.0 - 1.5

Question 19

What is the AVA for severe aortic stenosis

Answer 19

<1.0

Question 20

what are the class 1 indications for AVR

Answer 20

-Symptomatic severe high gradient AS (stage D1)
-Asymptomatic severe AS with LVEF <50% (Stage C2)
-Asymptomatic severe AS (Stage C1) undergoing cardiac surgery for other indications
-Symptomatic low-flow, low-gradient severe AS with normal EF
-Reasonable severe AS low surgical risk when exercise testing demonstrates decreased exercise tolerance of fall in SBP >10mmHg from baseline

Question 21

What are the class 2a indications for AVR

Answer 21

-reasonable in asymptomatic patients with severe AS and low surgical risk when serum BNP >3x normal
-considered in severe asymptomatic AS and progressive decrease in LVEF to at least <60% on at least 3 imaging studies

Question 22

what are the class 2B indications for AVR

Answer 22

may be considered in patients with moderate AS at the time of cardiac surgery for another indication

Question 23

When is SAVR preferred

Answer 23

-patients <65yo or with life expectancy >20 years
-vascular anatomy or other factors preclude TF TAVI
-asymptomatic patients with class 2a indication for intervention such as abnormal exercise test, very severe AS, rapid progression or elevated BNP

Question 24

When is TAVR preferred

Answer 24

-patients >80 years of age or with life expectancy <10 years
-symptomatic patients of any age with high or prohibitive surgical risk