Materiały źródłowe

• #1 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Aortic stenosis (AS) is the most common valvular heart disease in Europe and North America requiring a surgical or interventional treatment. […] As the onset of symptoms is associated with a decrease in life expectancy appropriate and early diagnosis are of utmost importance. […] The aim of this review is to display different diagnostic approaches that may be helpful in detecting patients with aortic valve stenosis. […] This review will focus on both non-invasive and invasive diagnostic approaches that can be implemented in clinical routine. […] We therefore aimed to conduct a review of the contemporary literature and provide invasive and non-invasive diagnostic approaches on the basis of the latest European guidelines that may be beneficial for detecting aortic valve stenosis in daily clinical practice.

• #2 Aortic Stenosis – Diagnosis

  https://www.my-connext.com/aortic-stenosis-disease/diagnosis?spec=21&cHash=8622fdafd119661d4ba4770d326233ad

  Aortic Stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America. It is present in approximately 2% of the general population with a rising prevalence in the elderly (up to 6% in patients above 85 years old). […] Primary care physicians should consider AS in adults presenting with any of the cardinal symptoms and/or those who have specific signs of AS on auscultation. […] Severe AS is clinically detected by a reduced valve area and severe hemodynamic deterioration. […] Exercise stress testing is recommended for risk stratification of asymptomatic AS patients. However, it is contraindicated in symptomatic AS patients. […] ECHOCARDIOGRAPHY is the primary diagnostic modality to diagnose AS, with doppler echocardiography being the preferred technique to determine the severity of AS. Echocardiography also provides information that is relevant for assessing the prognosis of AS and making therapeutic decisions, e.g. the need and urgency of valve intervention.

• #3 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Physical examination is an integral part of any primary doctor-patient contact and can play a key role for bedside diagnosis of suspected valvular heart disease. […] Aortic valve stenosis can be characterized by a systolic murmur that is audible with its maximum intensity in the second right intercostal space. […] The current ESC guidelines therefore do not suggest the use of a chest X-ray as a sufficient diagnostic tool. […] Echocardiography is the tool of choice for confirming the diagnosis of aortic valve stenosis. […] The current ESC 2021 guidelines for the management of valvular heart diseases consider echocardiography as the tool of choice for confirming the diagnosis of aortic valve stenosis. […] However, in cases of inconclusive results and measurements additional diagnostic approaches using cardial computer tomography (CCT), dobutamine stress echocardiography (DSE) and right- and left-sided heart catheterization should be considered. […] Auscultation, chest X-ray and ECG play a subordinate role due to their natural limitations and their low specificity and sensitivity for the diagnosis of AS.

• #4 Diagnosing Aortic Valve Disease | NYU Langone Health

  https://nyulangone.org/conditions/aortic-valve-disease/diagnosis

  At NYU Langone, our specialized heart valve physicians work as a team to diagnose and treat aortic valve stenosis and aortic valve regurgitation, the most common types of aortic valve disease. […] Although some people with aortic valve stenosis dont experience any symptoms, the narrowing of the aortic valve can cause heart palpitations, shortness of breath, chest pain, and fainting, typically with exertion. Your doctor may suspect aortic valve stenosis if during a routine physical exam he or she hears a heart murmur, which is an extra or unusual sound that occurs with a heartbeat. […] To help diagnose aortic valve disease, your doctor talks to you about your medical history and conducts a physical exam. Then he or she may request one or more of the following tests, which can typically be performed on the day of your initial doctors visit. […] These images provide valuable information that helps your doctor confirm your diagnosis and create a targeted treatment plan.

• #5 Aortic valve stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/aortic-valve-stenosis?lang=us

  Aortic valve stenosis is the most common valvulopathy and describes narrowing of the opening of the aortic valve between the aorta and the left ventricle. […] Clinical examination classically reveals a narrow pulse pressure, a slow-rising peripheral pulse, pulsus parvus et tardus (weak and delayed pulse) in the carotid pulse, a pressure-loaded („heaving”) apex beat, and a crescendo-decrescendo mid-systolic (or ejection systolic) murmur that is heard on precordial auscultation. […] Numerous clinical maneuvers can be used to distinguish aortic stenosis from the similar-sounding murmurs of hypertrophic obstructive cardiomyopathy and pulmonary valve stenosis, such as the Valsalva maneuver and auscultation during inspiration respectively. […] Echocardiography is useful for evaluating the anatomical location of the stenosis, either supravalvular, valvular, or subvalvular, for assessing the aortic valve area and jet velocity, and for assessing the left ventricle.

• #6 How the aortic valve pathology is diagnosed? – Tavispain

  https://tavispain.com/tavr-en/aortic-valve-pathology-diagnosis/

  The first step on diagnosing aortic stenosis uses to be its suspect after presenting any of the symptoms. […] In other occasions, a heart murmur during the auscultation is detected, and it consists on an abnormal sound due to the turbulence generating the narrowing of the aortic valve. […] In both cases, the specialist will decide the next step on the diagnosis process, which generally is the use of one of the following complementary tests (not necessarily in that order and not all of them): […] This test can identify the enlargement of the heart chambers, ventricular hypertrophy or arrhythmias, that provide more details for the diagnosis. […] Chest x-ray, on these cases, helps us to identify a heart or aorta enlargement, which is important in the diagnosis process of the aortic stenosis.

• #7 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient. […] Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. […] However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm2. […] The only physical examination finding that can exclude severe aortic stenosis is a normally split second heart sound. […] Classic symptoms of aortic stenosis accompanied by echocardiographic findings consistent with severe stenosis should prompt cardiology consultation. […] Aortic valve replacement is the only effective treatment for symptomatic, hemodynamically severe aortic stenosis.

• #8 Aortic Stenosis: Causes, Symptoms, Treatments

  https://www.medicinenet.com/aortic_stenosis/article.htm

  Aortic valve stenosis (AVS) is an abnormal narrowing of the aortic valve. […] How is aortic stenosis diagnosed? […] Patients with significant aortic stenosis have a delayed upstroke and lower intensity of the carotid pulse which correlates with the severity of narrowing. Aortic valve stenosis causes significant turbulence to blood flowing during contraction of the left ventricle resulting in a loud murmur. The loudness of the murmur does not, however, correlate with the severity of stenosis. Patients with mild stenosis can have loud murmurs, while patients with severe stenosis and heart failure may not pump enough blood to cause much of a murmur. […] Electrocardiogram (EKG): An EKG is a recording of the heart’s electrical activity. Abnormal patterns on the EKG can reflect a thickened heart muscle and suggest the diagnosis of aortic stenosis.

• #9 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Physical examination is an integral part of any primary doctor-patient contact and can play a key role for bedside diagnosis of suspected valvular heart disease. […] Aortic valve stenosis can be characterized by a systolic murmur that is audible with its maximum intensity in the second right intercostal space. […] The current ESC guidelines therefore do not suggest the use of a chest X-ray as a sufficient diagnostic tool. […] Echocardiography is the tool of choice for confirming the diagnosis of aortic valve stenosis. […] The current ESC 2021 guidelines for the management of valvular heart diseases consider echocardiography as the tool of choice for confirming the diagnosis of aortic valve stenosis. […] However, in cases of inconclusive results and measurements additional diagnostic approaches using cardial computer tomography (CCT), dobutamine stress echocardiography (DSE) and right- and left-sided heart catheterization should be considered. […] Auscultation, chest X-ray and ECG play a subordinate role due to their natural limitations and their low specificity and sensitivity for the diagnosis of AS.

• #10 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Echocardiography is indicated in patients with a loud unexplained systolic murmur, a single second heart sound, a history of a bicuspid aortic valve, or symptoms that may be caused by aortic stenosis. […] Transthoracic echocardiography, the recommended initial test for patients with suspected aortic stenosis, allows reliable identification of the number of valve leaflets and assessment of valve motion, leaflet calcification, and LV function.

• #11 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making. […] Transthoracic echocardiography (TTE) remains the cornerstone of the severe AS definition, based on aortic valve area (AVA) < 1.0 cm² or AVA indexed to body surface area—BSA—(AVAi) < 0.6 cm²/m² and the trans-valvular pressure mean gradient (TPG) ≥ 40 mm Hg or peak aortic jet velocity (Vmax) ≥ 4 m/s.

• #12 Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

  https://www.asecho.org/guideline/echocardiographic-assessment-of-aortic-valve-stenosis-a-focused-update/

  Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. […] Because clinical decision making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. […] Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. […] The document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice.

• #13 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Echocardiography is indicated in patients with a loud unexplained systolic murmur, a single second heart sound, a history of a bicuspid aortic valve, or symptoms that may be caused by aortic stenosis. […] Transthoracic echocardiography, the recommended initial test for patients with suspected aortic stenosis, allows reliable identification of the number of valve leaflets and assessment of valve motion, leaflet calcification, and LV function.

• #14 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  Aortic valve replacement should be recommended in most patients with any of these symptoms accompanied by evidence of significant aortic stenosis on echocardiography. […] Serial Doppler echocardiography is recommended annually for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Doppler echocardiography is the recommended initial test for patients with classic symptoms of aortic stenosis. […] Echocardiography also provides useful information about LV function, left ventricular filling pressure, and coexisting abnormalities of other valves. […] Isolated aortic stenosis rarely becomes symptomatic until the aortic valve area is less than 1 cm2, the mean gradient is greater than 40 mm Hg, or the aortic jet velocity is greater than 4 m per second.

• #15 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making. […] Transthoracic echocardiography (TTE) remains the cornerstone of the severe AS definition, based on aortic valve area (AVA) < 1.0 cm² or AVA indexed to body surface area—BSA—(AVAi) < 0.6 cm²/m² and the trans-valvular pressure mean gradient (TPG) ≥ 40 mm Hg or peak aortic jet velocity (Vmax) ≥ 4 m/s.

• #16 Low gradient severe aortic stenosis: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/low-gradient-severe-aortic-stenosis-clinical-manifestations-and-diagnosis

  Low gradient severe aortic stenosis: Clinical manifestations and diagnosis […] For appropriate diagnosis and management of AS, it is crucial to assess the severity of AS accurately as possible. However, the diagnosis and evaluation of AS is challenging due to a variety of pitfalls. […] Issues relating to the clinical manifestations and diagnosis of low gradient AS will be reviewed here. […] The 2020 American Heart Association/American College of Cardiology valvular heart disease guidelines identify severe aortic stenosis (AS) by the presence of an aortic transvalvular velocity ≥4 m/s and/or mean transvalvular pressure gradient ≥40 mmHg; the aortic valve area (AVA) is typically ≤1 cm² (with AVA indexed to body surface area ≤0.6 cm²/m²), although it may be larger with concurrent AS and aortic regurgitation. […] Low flow (stroke volume indexed to body surface area ≤35 mL/m²) severe AS and low gradient (transvalvular mean pressure gradient <40 mmHg) severe AS are partially overlapping categories of AS.

• #17 Valvular Emergencies: Diagnosis and Management of Severe Aortic stenosis | RECAPEM

  https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-aortic-stenosis/

  In the appropriate clinical context (historical clues, signs and symptoms), the presence of AS is suspected based on 2D echo findings. […] Diagnostic echo study is recommended. […] Severe AS is defined by aortic valve area (AVA) 1 cm2, aortic peak velocity 4 m/s, and/or mean gradient 40 mm Hg. […] Discordant grading is defined when one parameter suggests a moderate AS while the other suggests a severe AS. […] The above-mentioned criteria for grading severity of AS is not always consistent and the proportion of patients with discordant parameters is not negligible. […] Low gradient (LG) severe AS is suspected when the echocardiogram reveals an aortic valve area (AVA) 1 cm (with AVA indexed to body surface area 0.6 cm /m ) associated with a transvalvular mean pressure gradient 40 mmHg.

• #18 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient. […] Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. […] However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm2. […] The only physical examination finding that can exclude severe aortic stenosis is a normally split second heart sound. […] Classic symptoms of aortic stenosis accompanied by echocardiographic findings consistent with severe stenosis should prompt cardiology consultation. […] Aortic valve replacement is the only effective treatment for symptomatic, hemodynamically severe aortic stenosis.

• #19 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  Aortic valve replacement should be recommended in most patients with any of these symptoms accompanied by evidence of significant aortic stenosis on echocardiography. […] Serial Doppler echocardiography is recommended annually for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Doppler echocardiography is the recommended initial test for patients with classic symptoms of aortic stenosis. […] Echocardiography also provides useful information about LV function, left ventricular filling pressure, and coexisting abnormalities of other valves. […] Isolated aortic stenosis rarely becomes symptomatic until the aortic valve area is less than 1 cm2, the mean gradient is greater than 40 mm Hg, or the aortic jet velocity is greater than 4 m per second.

• #20 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient. […] Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. […] However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm2. […] The only physical examination finding that can exclude severe aortic stenosis is a normally split second heart sound. […] Classic symptoms of aortic stenosis accompanied by echocardiographic findings consistent with severe stenosis should prompt cardiology consultation. […] Aortic valve replacement is the only effective treatment for symptomatic, hemodynamically severe aortic stenosis.

• #21 Aortic valve stenosis: evaluation and management of patients with discordant grading

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Aortic-valve-stenosis-evaluation-and-management-of-patients-with-discordant-grading

  Echocardiographic assessment of the severity of aortic valve stenosis (AS) usually relies on peak velocity, mean pressure gradient (MPG) and aortic valve area (AVA), which should ideally be concordant. […] In most cases, these patients present with a normal flow (stroke volume index 35/ml/m), but low flow provides important prognostic information. […] To assess whether these patients truly present with severe AS, the calcium score should be measured using computed tomography (thresholds are 2,000 AU in males and 1,250 AU in females). […] A precise evaluation of the severity of aortic valve stenosis (AS) is crucial for patient management and risk stratification, and to allocate symptoms legitimately to the valvular disease. […] The last decade has seen this apparently easy and straightforward classification shaken up by the observation that up to one-third of patients present with discordant AS grading, and by the identification of a subset with paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction.

• #22 How the aortic valve pathology is diagnosed? – Tavispain

  https://tavispain.com/tavr-en/aortic-valve-pathology-diagnosis/

  On its transthoracic or transoesophageal modes, the echocardiogram is the main diagnosis test for analysing the aortic valve stenosis, as well as its consequences on the left ventricle. […] Those imaging tests can help us obtain details about the heart and the aorta, interesting for the aortic stenosis diagnosis and the choice of the most proper choice. […] In some cases, an invasive study of the heart may be necessary, through injection of some type of contrast in the heart and its arteries (coronary angiography) with the aim of evaluating different parameters, as the heart function or the features of the coronary arteries or those that would be used to introduce the valve through TAVI.

• #23 Aortic Valve Disease > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/aortic-valve-disease

  How is aortic valve disease diagnosed? To diagnose aortic valve disease, your doctor will review your medical history, perform a physical exam, and run diagnostic tests. […] They will begin to make a diagnosis by asking about your symptoms. During the physical exam, your doctor will check your blood pressure and pulse, and use a stethoscope to listen for a characteristic heart murmur or clicking sound. […] To confirm a diagnosis, your doctor will need to run one or more diagnostic tests. The main test for aortic valve disease is an echocardiogram. This test uses sound waves to produce images of the heart as it moves. Other imaging tests may be necessary, including a chest X-ray, a magnetic resonance imaging (MRI) study of the heart, or a computed tomography (CT) scan. […] Sometimes an electrocardiogram, also known as an ECG or EKG, is part of the workup. This test measures the hearts electrical activity, and while it is not used to diagnose aortic valve disease, it helps doctors evaluate how well the heart is working.

• #24 Aortic Stenosis – Diagnosis

  https://www.my-connext.com/aortic-stenosis-disease/diagnosis?spec=21&cHash=8622fdafd119661d4ba4770d326233ad

  CARDIAC MAGNETIC RESONANCE IMAGING (MRI) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification. […] MULTI-SLICE COMPUTED TOMOGRAPHY (MSCT) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification. It is also the preferred imaging tool for preprocedural patient evaluation and bioprosthetic valve sizing when Transcatheter Aortic Valve Implantation (TAVI) is considered. […] […] […] Diagnosis and management of valvular aortic stenosis. […] Aortic stenosis: diagnosis and management. […] […] […] Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. […] […] […] Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis.

• #25 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Current guidelines suggest that the timing of aortic valve replacement (AVR) is dependent on the development of symptoms or reduction in LVEF. […] The purpose of this review is to illustrate the imaging methods available today to assess the presence and severity of AS. […] TTE is a widely available, non-invasive and reliable technique which provides information on the severity of valve stenosis and its structural and functional impact on up- and down-stream cardiac structures. […] The effective orifice AVA is assessed by the continuity equation which assumes that the SV at the valve orifice level is equal to that at the LVOT. […] The main limitation in the assessment of AVA is the estimate of the LVOT diameter. […] The AS severity classification is shown in Table 1. […] The recent American guidelines recognize different stages of AS, ranging from patients at risk of AS (Stage A) or with progressive hemodynamic obstruction (Stage B) to severe asymptomatic (Stage C) and symptomatic AS (Stage D). […] Current recommendations for AVR in AS patients rely solely on mean TPG, AVA and the presence of symptoms.

• #26 Aortic valve stenosis: evaluation and management of patients with discordant grading

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Aortic-valve-stenosis-evaluation-and-management-of-patients-with-discordant-grading

  Therefore, the best way to address this issue is to use a quantitative and reliable flow-independent method for the assessment of AS severity, which is the remarkable characteristic of calcium scoring. […] Aortic valve calcium scoring is a quantitative and flow-independent method of assessing AS severity (recommended thresholds are 2,000 in men and 1,250 in women). […] Intervention is recommended in symptomatic patients with proven severe AS, as in classic severe AS.

• #27 Aortic valve stenosis: evaluation and management of patients with discordant grading

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Aortic-valve-stenosis-evaluation-and-management-of-patients-with-discordant-grading

  Therefore, the best way to address this issue is to use a quantitative and reliable flow-independent method for the assessment of AS severity, which is the remarkable characteristic of calcium scoring. […] Aortic valve calcium scoring is a quantitative and flow-independent method of assessing AS severity (recommended thresholds are 2,000 in men and 1,250 in women). […] Intervention is recommended in symptomatic patients with proven severe AS, as in classic severe AS.

• #28 Aortic stenosis – Echocardiography, diagnosis, grading, causes, management

  https://ecgwaves.com/topic/aortic-valve-stenosis/

  The majority of all patients with aortic stenosis can be diagnosed and monitored with echocardiography. […] Echocardiographic assessment of the severity of aortic valve stenosis relies on peak velocity, mean pressure gradient and aortic valve area (AVA), which should ideally be concordant. […] In 25% of patients these parameters are discordant (usually aortic valve area 1 cm and mean pressure gradient 40 mmHg). […] To assess whether these patients truly present with severe aortic stenosis, calcium score should be measured using computed tomography (thresholds are 2,000 AU in male and 1,250 AU in female).

• #29 Aortic Stenosis – Diagnosis

  https://www.my-connext.com/aortic-stenosis-disease/diagnosis?spec=21&cHash=8622fdafd119661d4ba4770d326233ad

  CARDIAC MAGNETIC RESONANCE IMAGING (MRI) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification. […] MULTI-SLICE COMPUTED TOMOGRAPHY (MSCT) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification. It is also the preferred imaging tool for preprocedural patient evaluation and bioprosthetic valve sizing when Transcatheter Aortic Valve Implantation (TAVI) is considered. […] […] […] Diagnosis and management of valvular aortic stenosis. […] Aortic stenosis: diagnosis and management. […] […] […] Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. […] […] […] Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis.

• #30 Clinical manifestations and diagnosis of aortic stenosis in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-aortic-stenosis-in-adults

  Chest radiograph […] Role of serial evaluation […] Additional testing based on clinical presentation […] • Patients with nondiagnostic noninvasive evaluation […] • Patients with a concurrent indication for coronary angiography […] • Asymptomatic sedentary patients […] • Patients with equivocal symptoms […] • Patients with low gradient aortic stenosis […] • Low-dose dobutamine stress echocardiogram […] • Computed tomography […] • Cardiovascular magnetic resonance […] • Positron emission tomography

• #31 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. […] Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. […] The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. […] The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients.

• #32 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is also recommended for asymptomatic patients with severe stenosis accompanied by LV systolic dysfunction (EF less than 50%). […] Watchful waiting is recommended for most asymptomatic patients with aortic stenosis, including those with severe disease. […] Attempts have been made to identify patients who are more likely to have poor outcomes without early aortic valve replacement. […] In patients whose symptom status is unclear, cautious exercise stress testing can objectively assess exercise tolerance or detect an abnormal blood pressure response. […] Surgical aortic valve replacement is the standard of care in patients with low or intermediate surgical risk. […] Transcatheter aortic valve replacement is recommended for patients who have an indication for valve replacement but are at prohibitive surgical risk.

• #33 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  Watchful waiting until symptoms are detected is appropriate in most patients with asymptomatic aortic stenosis. […] ACC/AHA guidelines recommend that serial Doppler echocardiography be performed annually for severe aortic stenosis, every one to two years for moderate aortic stenosis, and every three to five years for mild aortic stenosis.

• #34 Aortic Stenosis (Signs, Symptoms and Treatment)

  https://patient.info/doctor/aortic-stenosis-pro

  Aortic stenosis is the most common form of valvular heart disease in the elderly population and occurs frequently in conjunction with coronary artery disease. […] Echocardiography is the key diagnostic tool. It confirms the presence of AS, assesses the degree of valve calcification, left ventricular function and wall thickness, detects the presence of other associated valve disease or aortic pathology and provides prognostic information. […] Exercise testing is contra-indicated in symptomatic patients with AS but it is recommended in physically active patients for unmasking symptoms and in the risk stratification of asymptomatic patients with severe AS. […] The NICE guidelines state that current evidence supports the safety and efficacy of balloon valvuloplasty for aortic valve stenosis in adults and children. […] TAVI provides a method of AVR which does not carry the same risks as surgical AVR. […] The procedure is of equal efficacy as surgical AVR in patients who are unsuitable for surgery. […] AVR is the definitive therapy for severe AS.

• #35 Aortic Stenosis – Diagnosis

  https://www.my-connext.com/aortic-stenosis-disease/diagnosis?spec=21&cHash=8622fdafd119661d4ba4770d326233ad

  Aortic Stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America. It is present in approximately 2% of the general population with a rising prevalence in the elderly (up to 6% in patients above 85 years old). […] Primary care physicians should consider AS in adults presenting with any of the cardinal symptoms and/or those who have specific signs of AS on auscultation. […] Severe AS is clinically detected by a reduced valve area and severe hemodynamic deterioration. […] Exercise stress testing is recommended for risk stratification of asymptomatic AS patients. However, it is contraindicated in symptomatic AS patients. […] ECHOCARDIOGRAPHY is the primary diagnostic modality to diagnose AS, with doppler echocardiography being the preferred technique to determine the severity of AS. Echocardiography also provides information that is relevant for assessing the prognosis of AS and making therapeutic decisions, e.g. the need and urgency of valve intervention.

• #36 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Physical examination is an integral part of any primary doctor-patient contact and can play a key role for bedside diagnosis of suspected valvular heart disease. […] Aortic valve stenosis can be characterized by a systolic murmur that is audible with its maximum intensity in the second right intercostal space. […] The current ESC guidelines therefore do not suggest the use of a chest X-ray as a sufficient diagnostic tool. […] Echocardiography is the tool of choice for confirming the diagnosis of aortic valve stenosis. […] The current ESC 2021 guidelines for the management of valvular heart diseases consider echocardiography as the tool of choice for confirming the diagnosis of aortic valve stenosis. […] However, in cases of inconclusive results and measurements additional diagnostic approaches using cardial computer tomography (CCT), dobutamine stress echocardiography (DSE) and right- and left-sided heart catheterization should be considered. […] Auscultation, chest X-ray and ECG play a subordinate role due to their natural limitations and their low specificity and sensitivity for the diagnosis of AS.

• #37 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Diagnosis and classification of AS was considered quite simple in the past, based on transvalvular flow maximal velocity (VMax), mean gradient (MG), and valve area (AVA) which could be obtained with transthoracic echocardiography (TTE). […] A multimodality cardiac imaging approach (MCI) plays a key role in these scenarios. […] The objective of this review is to delve into the MCI used in the assessment of AS, highlighting the usefulness, strengths, and weaknesses of each imaging test, particularly in specific cases in which the grading of the disease is challenging. […] The addition of complementary techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR) allows a proper grading in most cases. […] In many cases, severe aortic stenosis is not a straightforward diagnosis. In all these challenging scenarios, multimodality cardiac imaging can lead to a higher precision grading and a better decision-making process.

• #38 Clinical manifestations and diagnosis of aortic stenosis in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-aortic-stenosis-in-adults

  Chest radiograph […] Role of serial evaluation […] Additional testing based on clinical presentation […] • Patients with nondiagnostic noninvasive evaluation […] • Patients with a concurrent indication for coronary angiography […] • Asymptomatic sedentary patients […] • Patients with equivocal symptoms […] • Patients with low gradient aortic stenosis […] • Low-dose dobutamine stress echocardiogram […] • Computed tomography […] • Cardiovascular magnetic resonance […] • Positron emission tomography

• #39 Valvular Emergencies: Diagnosis and Management of Severe Aortic stenosis | RECAPEM

  https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-aortic-stenosis/

  In the appropriate clinical context (historical clues, signs and symptoms), the presence of AS is suspected based on 2D echo findings. […] Diagnostic echo study is recommended. […] Severe AS is defined by aortic valve area (AVA) 1 cm2, aortic peak velocity 4 m/s, and/or mean gradient 40 mm Hg. […] Discordant grading is defined when one parameter suggests a moderate AS while the other suggests a severe AS. […] The above-mentioned criteria for grading severity of AS is not always consistent and the proportion of patients with discordant parameters is not negligible. […] Low gradient (LG) severe AS is suspected when the echocardiogram reveals an aortic valve area (AVA) 1 cm (with AVA indexed to body surface area 0.6 cm /m ) associated with a transvalvular mean pressure gradient 40 mmHg.

• #40 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Radionuclide studies to evaluate myocardial perfusion at rest and during exertion and exercise may be considered as part of the complete workup of aortic stenosis. […] Exercise stress testing is contraindicated in symptomatic patients with severe aortic stenosis, but it may be considered in asymptomatic patients with severe aortic stenosis. […] Three-dimensional (3D) volume quantification of aortic valve calcification using multislice computed tomography (CT) scanning demonstrates a close, nonlinear relationship to echocardiographic parameters for the severity of aortic stenosis. […] Even in the presence of significant aortic stenosis, the cardiac size often is normal, with rounding of the LV border and apex. […] Generally, ECG is not a reliable test for aortic stenosis. […] B-type natriuretic peptide (BNP) may provide incremental prognostic information in predicting symptom onset in asymptomatic patients with severe aortic stenosis.

• #41 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Physical examination is an integral part of any primary doctor-patient contact and can play a key role for bedside diagnosis of suspected valvular heart disease. […] Aortic valve stenosis can be characterized by a systolic murmur that is audible with its maximum intensity in the second right intercostal space. […] The current ESC guidelines therefore do not suggest the use of a chest X-ray as a sufficient diagnostic tool. […] Echocardiography is the tool of choice for confirming the diagnosis of aortic valve stenosis. […] The current ESC 2021 guidelines for the management of valvular heart diseases consider echocardiography as the tool of choice for confirming the diagnosis of aortic valve stenosis. […] However, in cases of inconclusive results and measurements additional diagnostic approaches using cardial computer tomography (CCT), dobutamine stress echocardiography (DSE) and right- and left-sided heart catheterization should be considered. […] Auscultation, chest X-ray and ECG play a subordinate role due to their natural limitations and their low specificity and sensitivity for the diagnosis of AS.

• #42 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Diagnostic studies in the emergency department should include electrocardiography (ECG), chest radiography, serum electrolyte levels, cardiac biomarkers, and a complete blood count (CBC). […] Two-dimensional and Doppler echocardiography is the imaging modality of choice to diagnose and determine the severity of aortic stenosis. […] In general, cardiac catheterization is not necessary to determine the severity of aortic stenosis. However, in instances in which clinical findings are not consistent with echocardiogram results, cardiac catheterization is recommended for further hemodynamic assessment. […] Two-dimensional transthoracic echocardiography can confirm the clinical diagnosis of aortic stenosis and provide specific data on LV function. […] The following 3 echocardiographic findings are indicative of severe aortic stenosis: An echo-dense aortic valve with no cusp motion, a decrease in the maximal aortic cusp separation ( 8 mm in the adult), and the presence of otherwise unexplained LV hypertrophy.

• #43 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Although the presence of aortic stenosis is readily diagnosed with 2D echocardiography, the severity of aortic stenosis cannot be judged based on the 2D echocardiographic images alone. Doppler echocardiography is an excellent tool for assessing the severity of aortic stenosis. […] The major limitation of Doppler echocardiography in assessing the severity of aortic stenosis is underestimation of the gradient if the sound beam is not parallel to the aortic stenosis velocity jet. […] Cardiac catheterization provides an accurate measure of aortic stenosis and is an important tool, particularly in patients who have discrepant clinical and echocardiographic findings. […] Measuring the LV end-diastolic and systolic volume and calculating the EF can quantitate the status of LV systolic pump function.

• #44 Congenital Aortic Stenosis | Symptoms, Diagnosis and Treatment

  https://www.cincinnatichildrens.org/health/a/avs

  Your doctor may order an exercise stress test if your child has aortic stenosis. The exercise stress test gives information about the impact of aortic stenosis on the function of the heart. […] Cardiac catheterization is an invasive technique that allows doctors to measure how much aortic stenosis is present. During cardiac catheterization, pressure measurements are made above and below the valve. This measures the amount of blockage. Pictures are taken to see the degree of valve obstruction. […] Echocardiography has replaced cardiac catheterization in many cases to find and measure aortic stenosis. […] From time to time, it may be necessary to do a cardiac catheterization to add to the information from the echo studies.

• #45 Exams and Tests

  http://www.cardiosmart.org/topics/aortic-stenosis/exams-and-tests

  Echocardiogram (heart ultrasound): A heart ultrasound is used to look at the structure and function of the heart. It is a fast and painless study that uses ultrasound waves to produce heart images. Your doctor may be able to identify the cause of aortic stenosis and look for other conditions you may have. He or she also can find out how narrow your aortic valve is and look for narrowing or leaks of the other valves. […] Cardiac Computed tomography (CAT scan): This test takes multiple X-rays to make detailed pictures of the heart. It is sometimes used to look for calcium deposits on the aortic valves and to guide certain procedures such as TAVR (a minimally invasive surgical procedure to repair an aortic valve). […] Cardiac Catheterization (heart catheterization or coronary angiogram): A heart catheterization is done to find out if you have disease of the heart muscle, valves or coronary (heart) arteries. During the procedure, the pressure and blood flow in your heart can be measured. A contrast dye visible in X-rays is injected through a catheter that is threaded from a blood vessel in your wrist or groin. X-ray images show the dye as it flows through the heart arteries and can show whether they are blocked. A coronary angiogram can be used to identify patients who also might benefit from surgery on the blood vessels around the heart along with an aortic valve replacement procedure.

• #46 Aortic Valve Disease > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/aortic-valve-disease

  Diagnosis sometimes requires cardiac catherization. In this procedure, a doctor inserts a catheter (a thin tube) into a vein or artery in the arm, neck, or groin. The doctor maneuvers the catheter through the blood vessel to the heart. Once in place, tiny devices inserted through the catheter are used to measure the pressure in the hearts chambers and the flow of blood through the hearts valves. X-rays of the heart (known as a coronary angiography) may also be taken during this procedure.

• #47 Exams and Tests

  http://www.cardiosmart.org/topics/aortic-stenosis/exams-and-tests

  Aortic stenosis is often found during an exam when the doctor listens to the heart and hears a heart murmur. But the loudness of the murmur doesn’t reflect the severity of stenosis. […] Other tests will be ordered to confirm the diagnosis and to determine the type of damage or issue with your heart valve. […] Tests include: […] Electrocardiogram (ECG): Calcium buildup linked to this condition may cause issues with the electrical system of the heart. This test also can reveal whether your heart muscle has grown thicker by showing changes in the electrical activity of the heart. […] Chest X-ray: The heart size often is normal, but other physical changes may be seen. For example, there might be a rounding of the heart border and tip of the heart (apex) because of a thickened heart muscle. Often, an enlarged aorta is seen just above the aortic valve.

• #48 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Radionuclide studies to evaluate myocardial perfusion at rest and during exertion and exercise may be considered as part of the complete workup of aortic stenosis. […] Exercise stress testing is contraindicated in symptomatic patients with severe aortic stenosis, but it may be considered in asymptomatic patients with severe aortic stenosis. […] Three-dimensional (3D) volume quantification of aortic valve calcification using multislice computed tomography (CT) scanning demonstrates a close, nonlinear relationship to echocardiographic parameters for the severity of aortic stenosis. […] Even in the presence of significant aortic stenosis, the cardiac size often is normal, with rounding of the LV border and apex. […] Generally, ECG is not a reliable test for aortic stenosis. […] B-type natriuretic peptide (BNP) may provide incremental prognostic information in predicting symptom onset in asymptomatic patients with severe aortic stenosis.

• #49 Exams and Tests

  http://www.cardiosmart.org/topics/aortic-stenosis/exams-and-tests

  Aortic stenosis is often found during an exam when the doctor listens to the heart and hears a heart murmur. But the loudness of the murmur doesn’t reflect the severity of stenosis. […] Other tests will be ordered to confirm the diagnosis and to determine the type of damage or issue with your heart valve. […] Tests include: […] Electrocardiogram (ECG): Calcium buildup linked to this condition may cause issues with the electrical system of the heart. This test also can reveal whether your heart muscle has grown thicker by showing changes in the electrical activity of the heart. […] Chest X-ray: The heart size often is normal, but other physical changes may be seen. For example, there might be a rounding of the heart border and tip of the heart (apex) because of a thickened heart muscle. Often, an enlarged aorta is seen just above the aortic valve.

• #50 Aortic stenosis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/aortic-stenosis

  Aortic stenosis is the abnormal narrowing, thickening and stiffening of the aortic valve, which restricts the flow of blood from the ventricle into the aorta. […] There are a variety of tests and examinations to help diagnose aortic stenosis. These include: physical examination including listening to the heart with a stethoscope (people with aortic stenosis may have a heart murmur) […] chest X-ray, to help see if the heart is enlarged and to see if there is a build-up of calcium in the aortic valve […] electrocardiogram (ECG), to monitor the heart rate and pick up any abnormal heart rhythms. An ECG can also help assess if the left ventricle is enlarged […] echocardiogram (ultrasound scan) of the heart, to assess how well the aortic valve and the left ventricle are working […] exercise tests or stress tests, to monitor how your heart works when you’re physically active. These tests usually involve either walking on a treadmill or riding a stationary bike while connected to a heart monitor

• #51 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Radionuclide studies to evaluate myocardial perfusion at rest and during exertion and exercise may be considered as part of the complete workup of aortic stenosis. […] Exercise stress testing is contraindicated in symptomatic patients with severe aortic stenosis, but it may be considered in asymptomatic patients with severe aortic stenosis. […] Three-dimensional (3D) volume quantification of aortic valve calcification using multislice computed tomography (CT) scanning demonstrates a close, nonlinear relationship to echocardiographic parameters for the severity of aortic stenosis. […] Even in the presence of significant aortic stenosis, the cardiac size often is normal, with rounding of the LV border and apex. […] Generally, ECG is not a reliable test for aortic stenosis. […] B-type natriuretic peptide (BNP) may provide incremental prognostic information in predicting symptom onset in asymptomatic patients with severe aortic stenosis.

• #52 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Physical examination is an integral part of any primary doctor-patient contact and can play a key role for bedside diagnosis of suspected valvular heart disease. […] Aortic valve stenosis can be characterized by a systolic murmur that is audible with its maximum intensity in the second right intercostal space. […] The current ESC guidelines therefore do not suggest the use of a chest X-ray as a sufficient diagnostic tool. […] Echocardiography is the tool of choice for confirming the diagnosis of aortic valve stenosis. […] The current ESC 2021 guidelines for the management of valvular heart diseases consider echocardiography as the tool of choice for confirming the diagnosis of aortic valve stenosis. […] However, in cases of inconclusive results and measurements additional diagnostic approaches using cardial computer tomography (CCT), dobutamine stress echocardiography (DSE) and right- and left-sided heart catheterization should be considered. […] Auscultation, chest X-ray and ECG play a subordinate role due to their natural limitations and their low specificity and sensitivity for the diagnosis of AS.

• #53 Aortic stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Aortic_stenosis

  Aortic stenosis is typically followed using repeated ultrasound scans. […] The standard for diagnosis of aortic stenosis is non-invasive testing with echocardiography. […] Echocardiogram (heart ultrasound) is the best non-invasive way to evaluate the aortic valve anatomy and function. […] Cardiac chamber catheterization provides a definitive diagnosis, indicating severe stenosis in valve area of 1.0 cm2 (normally about 3 cm2). […] For asymptomatic severe aortic valve stenosis, the European guidelines recommend B-type natriuretic peptide (BNP) measurements to aid risk stratification and optimize the timing of aortic valve replacement surgery. […] The use of CT calcium scoring is gaining spread as a diagnostic tool to complement echo in the assessment of patients with aortic stenosis.

• #54 Aortic Stenosis Workup: Approach Considerations, Echocardiography, Cardiac Catheterization and Coronary Arteriography

  https://emedicine.medscape.com/article/150638-workup

  Radionuclide studies to evaluate myocardial perfusion at rest and during exertion and exercise may be considered as part of the complete workup of aortic stenosis. […] Exercise stress testing is contraindicated in symptomatic patients with severe aortic stenosis, but it may be considered in asymptomatic patients with severe aortic stenosis. […] Three-dimensional (3D) volume quantification of aortic valve calcification using multislice computed tomography (CT) scanning demonstrates a close, nonlinear relationship to echocardiographic parameters for the severity of aortic stenosis. […] Even in the presence of significant aortic stenosis, the cardiac size often is normal, with rounding of the LV border and apex. […] Generally, ECG is not a reliable test for aortic stenosis. […] B-type natriuretic peptide (BNP) may provide incremental prognostic information in predicting symptom onset in asymptomatic patients with severe aortic stenosis.

• #55 Aortic Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/introduction-and-etiology

  Aortic stenosis occurs when the orifice of the aortic valve is significantly reduced due to the failure of the aortic valve leaflets to open fully during systole. […] The diagnosis of aortic stenosis is often made initially on physical examination and confirmed by echocardiography. […] Two-dimensional echocardiography can demonstrate a thickened aortic valve, reduced leaflet mobility and concentric left ventricular hypertrophy. The echocardiogram can also quantify aortic stenosis severity. […] The 2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease categorize aortic stenosis into four stages, including: risk of AS (Stage A), progressive hemodynamic obstruction (Stage B), asymptomatic severe AS (Stage C, with substages C1 and C2), and symptomatic severe AS (Stage D, with substages D1, D2, and D3).

• #56 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Current guidelines suggest that the timing of aortic valve replacement (AVR) is dependent on the development of symptoms or reduction in LVEF. […] The purpose of this review is to illustrate the imaging methods available today to assess the presence and severity of AS. […] TTE is a widely available, non-invasive and reliable technique which provides information on the severity of valve stenosis and its structural and functional impact on up- and down-stream cardiac structures. […] The effective orifice AVA is assessed by the continuity equation which assumes that the SV at the valve orifice level is equal to that at the LVOT. […] The main limitation in the assessment of AVA is the estimate of the LVOT diameter. […] The AS severity classification is shown in Table 1. […] The recent American guidelines recognize different stages of AS, ranging from patients at risk of AS (Stage A) or with progressive hemodynamic obstruction (Stage B) to severe asymptomatic (Stage C) and symptomatic AS (Stage D). […] Current recommendations for AVR in AS patients rely solely on mean TPG, AVA and the presence of symptoms.

• #57 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Current guidelines suggest that the timing of aortic valve replacement (AVR) is dependent on the development of symptoms or reduction in LVEF. […] The purpose of this review is to illustrate the imaging methods available today to assess the presence and severity of AS. […] TTE is a widely available, non-invasive and reliable technique which provides information on the severity of valve stenosis and its structural and functional impact on up- and down-stream cardiac structures. […] The effective orifice AVA is assessed by the continuity equation which assumes that the SV at the valve orifice level is equal to that at the LVOT. […] The main limitation in the assessment of AVA is the estimate of the LVOT diameter. […] The AS severity classification is shown in Table 1. […] The recent American guidelines recognize different stages of AS, ranging from patients at risk of AS (Stage A) or with progressive hemodynamic obstruction (Stage B) to severe asymptomatic (Stage C) and symptomatic AS (Stage D). […] Current recommendations for AVR in AS patients rely solely on mean TPG, AVA and the presence of symptoms.

• #58 Aortic Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/introduction-and-etiology

  Aortic stenosis occurs when the orifice of the aortic valve is significantly reduced due to the failure of the aortic valve leaflets to open fully during systole. […] The diagnosis of aortic stenosis is often made initially on physical examination and confirmed by echocardiography. […] Two-dimensional echocardiography can demonstrate a thickened aortic valve, reduced leaflet mobility and concentric left ventricular hypertrophy. The echocardiogram can also quantify aortic stenosis severity. […] The 2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease categorize aortic stenosis into four stages, including: risk of AS (Stage A), progressive hemodynamic obstruction (Stage B), asymptomatic severe AS (Stage C, with substages C1 and C2), and symptomatic severe AS (Stage D, with substages D1, D2, and D3).

• #59 Aortic Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/introduction-and-etiology

  Aortic stenosis occurs when the orifice of the aortic valve is significantly reduced due to the failure of the aortic valve leaflets to open fully during systole. […] The diagnosis of aortic stenosis is often made initially on physical examination and confirmed by echocardiography. […] Two-dimensional echocardiography can demonstrate a thickened aortic valve, reduced leaflet mobility and concentric left ventricular hypertrophy. The echocardiogram can also quantify aortic stenosis severity. […] The 2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease categorize aortic stenosis into four stages, including: risk of AS (Stage A), progressive hemodynamic obstruction (Stage B), asymptomatic severe AS (Stage C, with substages C1 and C2), and symptomatic severe AS (Stage D, with substages D1, D2, and D3).

• #60 Aortic Stenosis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23046-aortic-valve-stenosis

  Aortic valve stenosis (or aortic stenosis) happens when the aortic valve in your heart is narrowed or blocked. This interferes with the normal blood flow out of your heart. […] A cardiologist will typically diagnose this condition based on your symptoms (if you have them) and one or more of the following diagnostic tests: […] Your provider may look for swelling in your lower legs and ankles, and will also listen to your heart. Providers can often hear a heart murmur, a key sign of aortic stenosis, using a stethoscope. […] Based on your symptoms and how well your aortic valve works, your provider may describe your case with a letter and, possibly, a number after it. Stages run from A through D, with D being the worst. […] If you have stenosis but no symptoms, your healthcare provider may advise you to simply monitor the issue with follow-up visits and tests.

• #61 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Current guidelines suggest that the timing of aortic valve replacement (AVR) is dependent on the development of symptoms or reduction in LVEF. […] The purpose of this review is to illustrate the imaging methods available today to assess the presence and severity of AS. […] TTE is a widely available, non-invasive and reliable technique which provides information on the severity of valve stenosis and its structural and functional impact on up- and down-stream cardiac structures. […] The effective orifice AVA is assessed by the continuity equation which assumes that the SV at the valve orifice level is equal to that at the LVOT. […] The main limitation in the assessment of AVA is the estimate of the LVOT diameter. […] The AS severity classification is shown in Table 1. […] The recent American guidelines recognize different stages of AS, ranging from patients at risk of AS (Stage A) or with progressive hemodynamic obstruction (Stage B) to severe asymptomatic (Stage C) and symptomatic AS (Stage D). […] Current recommendations for AVR in AS patients rely solely on mean TPG, AVA and the presence of symptoms.

• #62 Aortic valve stenosis: evaluation and management of patients with discordant grading

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Aortic-valve-stenosis-evaluation-and-management-of-patients-with-discordant-grading

  Discordant grading is defined based upon the observation that one parameter suggests a moderate AS while the other suggests a severe AS. […] The importance of the third parameter, the LVOT TVI, is often underestimated. […] Finally, an AVA below 1 cm may also be observed in small-sized patients. […] Fulfilling the precise and rigorous methodology presented above, the rate of patients with discordant grading is still between 20% and 30%, thus representing a common clinical problem. […] Among 1,704 patients with a valve area below 1 cm, 24% presented with discordant grading (AVA 1 cm and MPG 40 mmHg). […] Importantly, this study also showed that the subset of patients with discordant grading (AVA 1 cm, MPG 40 mmHg) and a low flow had the worst prognosis. […] The fact that discordant grading is common and that low flow is rare but impacts on prognosis is of no help in assessing whether these patients truly presented severe AS.

• #63 Low gradient severe aortic stenosis: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/low-gradient-severe-aortic-stenosis-clinical-manifestations-and-diagnosis

  Low gradient severe aortic stenosis: Clinical manifestations and diagnosis […] For appropriate diagnosis and management of AS, it is crucial to assess the severity of AS accurately as possible. However, the diagnosis and evaluation of AS is challenging due to a variety of pitfalls. […] Issues relating to the clinical manifestations and diagnosis of low gradient AS will be reviewed here. […] The 2020 American Heart Association/American College of Cardiology valvular heart disease guidelines identify severe aortic stenosis (AS) by the presence of an aortic transvalvular velocity ≥4 m/s and/or mean transvalvular pressure gradient ≥40 mmHg; the aortic valve area (AVA) is typically ≤1 cm² (with AVA indexed to body surface area ≤0.6 cm²/m²), although it may be larger with concurrent AS and aortic regurgitation. […] Low flow (stroke volume indexed to body surface area ≤35 mL/m²) severe AS and low gradient (transvalvular mean pressure gradient <40 mmHg) severe AS are partially overlapping categories of AS.

• #64 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Diagnosis and classification of AS was considered quite simple in the past, based on transvalvular flow maximal velocity (VMax), mean gradient (MG), and valve area (AVA) which could be obtained with transthoracic echocardiography (TTE). […] A multimodality cardiac imaging approach (MCI) plays a key role in these scenarios. […] The objective of this review is to delve into the MCI used in the assessment of AS, highlighting the usefulness, strengths, and weaknesses of each imaging test, particularly in specific cases in which the grading of the disease is challenging. […] The addition of complementary techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR) allows a proper grading in most cases. […] In many cases, severe aortic stenosis is not a straightforward diagnosis. In all these challenging scenarios, multimodality cardiac imaging can lead to a higher precision grading and a better decision-making process.

• #65 Valvular Emergencies: Diagnosis and Management of Severe Aortic stenosis | RECAPEM

  https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-aortic-stenosis/

  In the appropriate clinical context (historical clues, signs and symptoms), the presence of AS is suspected based on 2D echo findings. […] Diagnostic echo study is recommended. […] Severe AS is defined by aortic valve area (AVA) 1 cm2, aortic peak velocity 4 m/s, and/or mean gradient 40 mm Hg. […] Discordant grading is defined when one parameter suggests a moderate AS while the other suggests a severe AS. […] The above-mentioned criteria for grading severity of AS is not always consistent and the proportion of patients with discordant parameters is not negligible. […] Low gradient (LG) severe AS is suspected when the echocardiogram reveals an aortic valve area (AVA) 1 cm (with AVA indexed to body surface area 0.6 cm /m ) associated with a transvalvular mean pressure gradient 40 mmHg.

• #66 Low gradient severe aortic stenosis: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/low-gradient-severe-aortic-stenosis-clinical-manifestations-and-diagnosis

  Low gradient severe aortic stenosis: Clinical manifestations and diagnosis […] For appropriate diagnosis and management of AS, it is crucial to assess the severity of AS accurately as possible. However, the diagnosis and evaluation of AS is challenging due to a variety of pitfalls. […] Issues relating to the clinical manifestations and diagnosis of low gradient AS will be reviewed here. […] The 2020 American Heart Association/American College of Cardiology valvular heart disease guidelines identify severe aortic stenosis (AS) by the presence of an aortic transvalvular velocity ≥4 m/s and/or mean transvalvular pressure gradient ≥40 mmHg; the aortic valve area (AVA) is typically ≤1 cm² (with AVA indexed to body surface area ≤0.6 cm²/m²), although it may be larger with concurrent AS and aortic regurgitation. […] Low flow (stroke volume indexed to body surface area ≤35 mL/m²) severe AS and low gradient (transvalvular mean pressure gradient <40 mmHg) severe AS are partially overlapping categories of AS.

• #67 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Diagnosis and classification of AS was considered quite simple in the past, based on transvalvular flow maximal velocity (VMax), mean gradient (MG), and valve area (AVA) which could be obtained with transthoracic echocardiography (TTE). […] A multimodality cardiac imaging approach (MCI) plays a key role in these scenarios. […] The objective of this review is to delve into the MCI used in the assessment of AS, highlighting the usefulness, strengths, and weaknesses of each imaging test, particularly in specific cases in which the grading of the disease is challenging. […] The addition of complementary techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR) allows a proper grading in most cases. […] In many cases, severe aortic stenosis is not a straightforward diagnosis. In all these challenging scenarios, multimodality cardiac imaging can lead to a higher precision grading and a better decision-making process.

• #68 Valvular Emergencies: Diagnosis and Management of Severe Aortic stenosis | RECAPEM

  https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-aortic-stenosis/

  A diagnostic approach for assessing AS in different flow-gradient scenarios is provided. […] The goal of medical therapy and mechanical circulatory support (MCS) is stabilization prior to definitive correction of the lesion. […] Surgical aortic valve replacement is often considered the gold standard for severe AS treatment. However, patients with severe AS presenting with CS have high surgical risk, and thus transcatheter aortic valve implementation (TAVI) is now the preferred definitive treatment in this population.

• #69 Aortic Stenosis: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/26926974/

  Aortic stenosis affects 3% of persons older than 65 years. […] Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Cardiology referral is recommended for all patients with symptomatic moderate and severe aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular systolic dysfunction.

• #70 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Echocardiography is indicated in patients with a loud unexplained systolic murmur, a single second heart sound, a history of a bicuspid aortic valve, or symptoms that may be caused by aortic stenosis. […] Transthoracic echocardiography, the recommended initial test for patients with suspected aortic stenosis, allows reliable identification of the number of valve leaflets and assessment of valve motion, leaflet calcification, and LV function.

• #71 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  Watchful waiting until symptoms are detected is appropriate in most patients with asymptomatic aortic stenosis. […] ACC/AHA guidelines recommend that serial Doppler echocardiography be performed annually for severe aortic stenosis, every one to two years for moderate aortic stenosis, and every three to five years for mild aortic stenosis.

• #72 Aortic Stenosis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23046-aortic-valve-stenosis

  If you develop symptoms, your provider can offer you aortic stenosis treatment options, including: […] Valve replacement offers several options for people who cant have a valve repair. […] Your outlook with aortic stenosis depends on how quickly you get treatment. […] Untreated aortic stenosis can cause big disruptions in your life, especially once it becomes severe or critical. […] With timely or early treatment, the prognosis for aortic stenosis is good or excellent. […] If you have mild aortic stenosis or no symptoms, you may only need routine echocardiograms and regular follow-up appointments. […] If you choose not to have treatment or havent received treatment yet, you should call your healthcare provider if the following happens: […] Talking to a healthcare provider about aortic stenosis sooner rather than later, especially if you have symptoms, can make a huge difference in your life.

• #73 Managing Aortic Stenosis Symptoms    | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptoms

  You may have been surprised when your doctor said you have aortic stenosis (AS), a defect that can narrow the aortic valve opening and restrict blood flow out of the heart to the aorta. […] If AS is suspected, an echocardiogram can be done to confirm the diagnosis. An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to create pictures of your heart including the heart valves. […] Routine echocardiograms can show if the condition has advanced. […] Follow your doctor’s recommendations about how often you need follow-up visits and tests to monitor your aortic valve. […] Once it has been determined that your aortic valve needs to be replaced, your doctor will discuss treatment options to help you decide which valve replacement procedure is best for you.

• #74 Managing Aortic Stenosis Symptoms    | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptoms

  You may have been surprised when your doctor said you have aortic stenosis (AS), a defect that can narrow the aortic valve opening and restrict blood flow out of the heart to the aorta. […] If AS is suspected, an echocardiogram can be done to confirm the diagnosis. An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to create pictures of your heart including the heart valves. […] Routine echocardiograms can show if the condition has advanced. […] Follow your doctor’s recommendations about how often you need follow-up visits and tests to monitor your aortic valve. […] Once it has been determined that your aortic valve needs to be replaced, your doctor will discuss treatment options to help you decide which valve replacement procedure is best for you.

• #75 Aortic Stenosis: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/26926974/

  Aortic stenosis affects 3% of persons older than 65 years. […] Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. […] Cardiology referral is recommended for all patients with symptomatic moderate and severe aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular systolic dysfunction.

• #76 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient. […] Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. […] However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm2. […] The only physical examination finding that can exclude severe aortic stenosis is a normally split second heart sound. […] Classic symptoms of aortic stenosis accompanied by echocardiographic findings consistent with severe stenosis should prompt cardiology consultation. […] Aortic valve replacement is the only effective treatment for symptomatic, hemodynamically severe aortic stenosis.

• #77 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  It is essential that primary care physicians consider aortic stenosis in adults who present with any of the classic symptoms accompanied by a systolic murmur. […] American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines recommend echocardiography in asymptomatic patients with a grade 3/6 or louder systolic murmur. […] In symptomatic patients with echocardiographic measures consistent with severe aortic stenosis, symptoms must be presumed to be a result of aortic stenosis, even if other potentially causative conditions, such as CAD, are present. […] Aortic valve replacement is also recommended for asymptomatic patients with severe aortic stenosis accompanied by LV systolic dysfunction (i.e., ejection fraction of less than 50 percent). […] When severe aortic stenosis is shown to be the primary pathology in this setting, aortic valve replacement is a lifesaving therapy and improves LV function.

• #78 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  It is essential that primary care physicians consider aortic stenosis in adults who present with any of the classic symptoms accompanied by a systolic murmur. […] American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines recommend echocardiography in asymptomatic patients with a grade 3/6 or louder systolic murmur. […] In symptomatic patients with echocardiographic measures consistent with severe aortic stenosis, symptoms must be presumed to be a result of aortic stenosis, even if other potentially causative conditions, such as CAD, are present. […] Aortic valve replacement is also recommended for asymptomatic patients with severe aortic stenosis accompanied by LV systolic dysfunction (i.e., ejection fraction of less than 50 percent). […] When severe aortic stenosis is shown to be the primary pathology in this setting, aortic valve replacement is a lifesaving therapy and improves LV function.

• #79 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Diagnosis and classification of AS was considered quite simple in the past, based on transvalvular flow maximal velocity (VMax), mean gradient (MG), and valve area (AVA) which could be obtained with transthoracic echocardiography (TTE). […] A multimodality cardiac imaging approach (MCI) plays a key role in these scenarios. […] The objective of this review is to delve into the MCI used in the assessment of AS, highlighting the usefulness, strengths, and weaknesses of each imaging test, particularly in specific cases in which the grading of the disease is challenging. […] The addition of complementary techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR) allows a proper grading in most cases. […] In many cases, severe aortic stenosis is not a straightforward diagnosis. In all these challenging scenarios, multimodality cardiac imaging can lead to a higher precision grading and a better decision-making process.

• #80 Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

  https://www.asecho.org/guideline/echocardiographic-assessment-of-aortic-valve-stenosis-a-focused-update/

  Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. […] Because clinical decision making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. […] Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. […] The document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice.

• #81 Aortic Stenosis: Diagnosis and Management – Sentara

  https://www.sentaraproviderresources.com/videos/aortic-stenosis-diagnosis-and-management

  A valvuloplasty is not as good as replacing the valve, but we stretch the valve with a balloon tends to last something like six months. […] We consider tver transcatheter aortic valve replacement, which is what we see in the hybrid. […] We go through the patients. Our A PP team does an amazing job putting together a powerpoint that has all the relevant data captured and we figure out together of this spectrum. […] TAVR is a minimally invasive cardiac procedure for patients with aortic valve stenosis at low, intermediate or high risk for standard valve replacement surgery. […] Deepak R. Talreja, M.D., discusses the workup for patients with severe aortic stenosis who are interested in Transcatheter Aortic Valve Replacement (TAVR) and what steps you need to do to determine their eligibility.

• #82 Aortic Valve Stenosis: Causes, Diagnosis, and Treatment

  https://www.rupahealth.com/post/aortic-valve-stenosis-causes-diagnosis-treatment

  Aortic valve stenosis is a progressive narrowing of the heart’s aortic valve opening, which can affect blood flow from the left ventricle into the aorta. This article reviews the causes, diagnostic procedures, and management options for aortic valve stenosis. […] Diagnosing AV stenosis involves assessing the severity of valve narrowing. Diagnosis is achieved by: […] The diagnostic process often begins with a clinical evaluation by a healthcare provider. They will review the individual’s medical history, including any symptoms suggestive of AV stenosis, such as chest pain, shortness of breath, or fatigue. The physical examination can reveal signs like a heart murmur or abnormal heart sounds. […] Echocardiography is the primary imaging test used to diagnose AV stenosis. It provides detailed images of the heart’s structures, allowing assessment of valve morphology, function, and blood flow across the valve. […] Cardiac catheterization may be performed to confirm the diagnosis of AV stenosis and assess coronary artery anatomy if surgical intervention is being considered. […] Diagnosing and managing AV stenosis requires a multidisciplinary team, including cardiologists, cardiac surgeons, and other specialists, to develop the most suitable management approach tailored to the patient’s needs.

• #83 Aortic Stenosis: Diagnosis and Management – Sentara

  https://www.sentaraproviderresources.com/videos/aortic-stenosis-diagnosis-and-management

  A valvuloplasty is not as good as replacing the valve, but we stretch the valve with a balloon tends to last something like six months. […] We consider tver transcatheter aortic valve replacement, which is what we see in the hybrid. […] We go through the patients. Our A PP team does an amazing job putting together a powerpoint that has all the relevant data captured and we figure out together of this spectrum. […] TAVR is a minimally invasive cardiac procedure for patients with aortic valve stenosis at low, intermediate or high risk for standard valve replacement surgery. […] Deepak R. Talreja, M.D., discusses the workup for patients with severe aortic stenosis who are interested in Transcatheter Aortic Valve Replacement (TAVR) and what steps you need to do to determine their eligibility.

• #84 Aortic Valve Stenosis: Diagnostic Approaches and Recommendations of the 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease –A Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9410571/

  Aortic stenosis (AS) is the most common valvular heart disease in Europe and North America requiring a surgical or interventional treatment. […] As the onset of symptoms is associated with a decrease in life expectancy appropriate and early diagnosis are of utmost importance. […] The aim of this review is to display different diagnostic approaches that may be helpful in detecting patients with aortic valve stenosis. […] This review will focus on both non-invasive and invasive diagnostic approaches that can be implemented in clinical routine. […] We therefore aimed to conduct a review of the contemporary literature and provide invasive and non-invasive diagnostic approaches on the basis of the latest European guidelines that may be beneficial for detecting aortic valve stenosis in daily clinical practice.

• #85 Aortic Valve Stenosis – Current View on Diagnostics and Treatment | IntechOpen

  https://www.intechopen.com/books/1294

  Currently, aortic stenosis is the most frequent heart valve disease in developed countries and its prevalence increases with the aging of the population. […] This book tries to cover current issues of aortic valve stenosis management with stress on new trends in diagnostics and treatment.

• #86 Diagnostic Challenges in Aortic Stenosis

  https://www.mdpi.com/2308-3425/11/6/162

  Diagnosis and classification of AS was considered quite simple in the past, based on transvalvular flow maximal velocity (VMax), mean gradient (MG), and valve area (AVA) which could be obtained with transthoracic echocardiography (TTE). […] A multimodality cardiac imaging approach (MCI) plays a key role in these scenarios. […] The objective of this review is to delve into the MCI used in the assessment of AS, highlighting the usefulness, strengths, and weaknesses of each imaging test, particularly in specific cases in which the grading of the disease is challenging. […] The addition of complementary techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR) allows a proper grading in most cases. […] In many cases, severe aortic stenosis is not a straightforward diagnosis. In all these challenging scenarios, multimodality cardiac imaging can lead to a higher precision grading and a better decision-making process.

• #87 Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

  https://www.mdpi.com/2077-0383/10/16/3745

  Current guidelines suggest that the timing of aortic valve replacement (AVR) is dependent on the development of symptoms or reduction in LVEF. […] The purpose of this review is to illustrate the imaging methods available today to assess the presence and severity of AS. […] TTE is a widely available, non-invasive and reliable technique which provides information on the severity of valve stenosis and its structural and functional impact on up- and down-stream cardiac structures. […] The effective orifice AVA is assessed by the continuity equation which assumes that the SV at the valve orifice level is equal to that at the LVOT. […] The main limitation in the assessment of AVA is the estimate of the LVOT diameter. […] The AS severity classification is shown in Table 1. […] The recent American guidelines recognize different stages of AS, ranging from patients at risk of AS (Stage A) or with progressive hemodynamic obstruction (Stage B) to severe asymptomatic (Stage C) and symptomatic AS (Stage D). […] Current recommendations for AVR in AS patients rely solely on mean TPG, AVA and the presence of symptoms.

• #88 Aortic Valve Disease | UNC Heart Valve Clinic

  https://www.med.unc.edu/medicine/cardiology/uncheartvalve/diseases-and-treatments/aortic-valve-disease/

  TAVR is now an option for patients in all risk categories including inoperable, high, intermediate, and low surgical risk. […] Severe symptomatic aortic stenosis is a life threatening condition. […] With TAVR, physicians now have the ability to provide aortic valve replacement via minimally-invasive approaches, including percutaneous procedures (intervention without an incision), which provide outcomes that are as good, or sometimes better than, surgical valve replacement. […] Patients benefit greatly when they can be evaluated by a multidisciplinary team, who then together decide on the best treatment option and provide the highest level of care. […] By pooling knowledge, expertise, and resources, all options are evaluated, allowing the physicians in the UNC Valve Clinic to provide the best patient care. […] When traditional open heart surgery is needed for your aortic valve, you want a team of surgeons who offer the highest level of care and the most treatment options.

• #89 Aortic Stenosis: Diagnosis and Management – Sentara

  https://www.sentaraproviderresources.com/videos/aortic-stenosis-diagnosis-and-management

  A valvuloplasty is not as good as replacing the valve, but we stretch the valve with a balloon tends to last something like six months. […] We consider tver transcatheter aortic valve replacement, which is what we see in the hybrid. […] We go through the patients. Our A PP team does an amazing job putting together a powerpoint that has all the relevant data captured and we figure out together of this spectrum. […] TAVR is a minimally invasive cardiac procedure for patients with aortic valve stenosis at low, intermediate or high risk for standard valve replacement surgery. […] Deepak R. Talreja, M.D., discusses the workup for patients with severe aortic stenosis who are interested in Transcatheter Aortic Valve Replacement (TAVR) and what steps you need to do to determine their eligibility.

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