Aortic Stenosis Guidlines

Question 1

Mild AS

Answer 1

AVA: 1.5-2.5

Mean Gr: <20 mmHg

velocity: 2-3 m/s

Question 2

Moderate AS

Answer 2

AVA: 1-1.5

Mean GR: 20-40 mmHg

Velocity: 3-4 m/s

Question 3

Severe As

Answer 3

AVA:

mean GR: >40 mmHg

Velocity: >4 m/s

Question 4

Stage A AS

Answer 4

— At risk

• BAV, AV sclerosis
• V max < 2m/s

Question 5

Stage B AS

Answer 5

— Progressive AS

• mild-mod leaflet calc.
• rheumatic valve comm fusion
• Normal LVEF
• no Sx

Question 6

Stage C AS

Answer 6

Asymptomatic severe AS

Question 7

Stage C1 AS

Answer 7

— Asymptomatic severe AS

• severe calc
• congenital stenosis
• LV diastolic dysfunction
• normal EF

Question 8

Stage C2 AS

Answer 8

— Asymptomatic severe AS with LV dysfunction

• Severe calc
• congenital stenosis
• LV sys dysfunction
• EF < 50%

Question 9

Stage D AS

Answer 9

Symptomatic severe AS

Question 10

Stage D1 AS

Answer 10

— Sx, severe high gradient AS

• severe leaflet calc or cong stenosis
• severe reduced leaflet opening
• LV diastolic dys, LV hypert, +- PHT
• dyspnea, anigina syncope

Question 11

Stage D2 AS

Answer 11

— Sx severe low flow/low Gr AS

• severe leaflet calc
• reduced leafltet motion
• LV diast dysf, LV hypert, EF <50%
• HF, angina, syncope

Question 12

Stage D3 AS

Answer 12

— Sx severe low Gr AS with normal EF

• or paradoxical low flow severe AS
• severely reduced leaflet motion
• increased LV wall TH, small LV chamber
• resticctive diastolic filling, EF <50%
• HF, angina, Syncope

Question 13

Class I (B)

Answer 13

– AVR: Sx + sev. high GR AS (D1) + Sx on hx or ex T

– AVR: Asx + sev AS (C2) + EF < 50%

— AVR: sev AS (C or D) + other cardiac S

Question 14

Class IIa (B)

Answer 14

AVR : ASx + very sev AS (C1), vel>5m/s + low surg risk

AVR: Asx + sev AS (C1) + exercise int as fall in BP

AVR: low flow/ low GR sev AS +low EF (D2) + ve dob E

Question 15

Class IIa (C)

Answer 15

— AVR: Sx + low flow/ low GR sev AS (D3) normotensive and have normal EF if all date supp valve obstruc. as cause of Sx

— AVR: mod AS (B) + another cardiac surgery

Question 16

Class IIb (C)

Answer 16

AVR maybe considered for Asx with sev AS (C1) + rapid disease progression + low risk

Question 17

Asx AS ind for AVR

Answer 17

• (B) mod + another Ht surg (IIa C)
• (C1) severe + another Ht Surg (I B)
• (C1) very severe (IIa B)
• (C1) severe + exercise int. (IIa B)
• (C1) severe + rap dis. progression (IIb C)
• (C2) severe with EF < 50% (I B)