Aortic stenosis might be associated with low transvalvular gradient when transvalvular flow is diminished
Abstract
Vast majority of patients in this group are patients with left ventricular dysfunction. This this condition is coupled with several potential difficulties: 1. difficulties with precise quantification of stenosis grade and its differentiation from so called pseudostenosis: 2. second important question is which patient will profit from operative approach.
Useful may be comparison of measurement in basic state versus state with measurement performed under augmented flow. The most common way is dobutamine stress echocardiography.
It is useful for distinguishing true stenosis from pseudostenosis as well as for assessment of contractile reserve. Indeed, we are still lacking precise and comprehensive guidelines for treatment of patients with low flow aortic stenosis.
So far, it seems, that patients with tight aortic stenosis, left ventricular dysfunction in which contractile reserve of left ventricle is present are those who will profit from aortic valve replacement.