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(BQ) Part 2 book Aortic stenosis - Case-Based diagnosis and therapy presents the following contents: Reverse area and gradient mismatch - the discordance of a large valve area and high gradients, prosthetic aortic valves and diagnostic challenges, risk prediction models, guidelines, special populations and outcomes, surgical management of aortic valve stenosis, balloon aortic valvuloplasty,...
8 Area and Gradient Mismatch: The Discordance of a Small Valve Area and Low Gradients Laura M Franey, Steven J Lester, Frances O Wood, and Amr E Abbas Abstract While the clinical severity of aortic stenosis (AS) is based largely on symptoms, indications for surgical aortic valve replacement (SAVR) and/or transcutaneous (TAVR) rely upon calculated estimates of the hemodynamic significance and degree of valvular stenosis Severe AS is defined as an aortic valve area (AVA) 4 m/s by Doppler echocardiography Whether the above conditions must be met individually or collectively remains unclear As noted, “area/ gradient match” occurs when both the AVA and ∆P fall within the severe range This may occur regardless of the presence of normal or abnormal ejection fraction and regardless of the presence or absence of low flow (defined as a stroke volume index on echocardiography