Paradoxical low-flow low-gradient aortic stenosis

• Published in: Der Internist (Berlin) Vol. 57; no. 4; pp. 317 - 322
• Main Authors: Ten Freyhaus, H, Baldus, S
• Format: Journal Article
• Language: German
• Published: Germany 01-04-2016
• Subjects: Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - therapy; Diagnosis, Differential; Echocardiography - methods; Evidence-Based Medicine; Heart Valve Prosthesis Implantation; Humans; Preoperative Care - methods; Tomography, X-Ray Computed - methods; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - prevention & control; Echocardiography, stress; Aortic valve replacement; Echocardiography; Aortic stenosis, pseudosevere; Stroke volume
• ISSN: 1432-1289
• DOI: 10.1007/s00108-016-0027-9

In approximately one third of patients presenting with suspected severe aortic stenosis, there is a discrepancy between a severely reduced aortic valve opening area (< 1 cm(2)) and a non-severe increase of the mean transvalvular gradient (< 40 mmHg). In a substantial number of these cases there is evidence of a severe paradoxical low-flow low-gradient aortic stenosis, characterized by a reduced stroke volume index in the setting of a normal left ventricular ejection fraction. This finding should trigger an extensive diagnostic work-up, including echocardiography, stress echocardiography and computed tomography to rule out measurement errors and to identify the cause(s) of the hemodynamic discrepancy. If the diagnosis of a severe paradoxical low-flow low-gradient aortic stenosis is confirmed and, furthermore, the patient is normotensive and reports stenosis-associated symptoms, the feasibility of an aortic valve replacement should be considered.