Cor Vasa 2017, 59(1):e17-e22 | DOI: 10.1016/j.crvasa.2017.01.023

Management of low-gradient aortic stenosis

Martin Mates^*, Karel Kopřiva

Kardiologické oddělení, Komplexní kardiovaskulární centrum, Nemocnice Na Homolce, Praha, Česká republika

There is an important proportion of patients with significant aortic stenosis who present with low gradient. In clinical practice we distinguish three subpopulations: (1) "classical" type with low left ventricular ejection fraction, (2) paradoxical type with preserved ventricular ejection fraction and (3) patients with normal flow and low gradient. Differentiation between "true" severe aortic stenosis and pseudostenosis by means of low dose dobutamine stress test is sometimes necessary in order to set further management - operative or conservative respectively. Use of other imaging methods such as MSCT, proved also valuable. Intervention of severe aortic stenosis in such cases is considered to be superior with regards to survival, though very high operative risk in some subgroups, typically for patients with low ejection fraction, has been reported.

Keywords: Aortic stenosis; Aortic valve replacement; Echocardiography; Low flow; Low gradient; Transcatheter aortic valve replacement

Received: October 21, 2016; Accepted: January 12, 2017; Published: February 1, 2017  Show citation