Aortic Stenosis

#med #disease #y2023 #cardio

Presentation :

Severe aortic stenosis is typically defined by TTE showing a small valve area (≤1.0 cm2); high peak velocity (>4 m/s); and/or high mean gradient (>40 mm Hg).
For patients with low-flow, low-gradient aortic stenosis (2/2 severe LV dysfunction and low cardiac output):
- dobutamine echocardiography/cardiac catheterization is needed to distinguish true aortic stenosis from pseudostenosis
For patients with paradoxical low-flow, low-gradient aortic stenosis (2/2 preserved LV function but with small LV size and high aortic impedance to flow (e.g., hypertension) or other causes of low cardiac output (e.g., afib, pulm HTN):
- Consideration of the hemodynamics, valve morphology (e.g., degree of calcification), presence of LV hypertrophy, and clinical presentation
- Measurement of aortic valve calcium score by CT is reasonable to further define severity

Indications for aortic valve replacement in severe AS are:
- symptoms of dyspnea, angina, presyncope, syncope, or HF
- ejection fraction <50% in an asymptomatic patient
- a concomitant cardiac surgical procedure for other indications (CABG, ascending aorta repair, etc)
TAVR is preferred if:
- aged >80 years
- younger patients with <10 years' life expectancy
- any age with a high or prohibitive surgical risk