Low flow low gradient aortic stenosis resident survival guide: Difference between revisions
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Rim Halaby (talk | contribs) (Created page with "_NOTOC__ {{CMG}}; {{AE}} {{Rim}} ==Overview== ==Management== Shown below is an algorithm of the management of low flow, low gradient aortic stenosis.<ref name="pmid23062546"...") |
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{{familytree | | | A01 | | | | | | boxstyle=background: WhiteSmoke| A01= '''Ultrasound evaluation of aortic stenosis'''<br> Effective orifice area (EOA)≤ 1 cm<sup>2</sup><br> Pressure gradient (ΔP)<40 mmHg}} | |||
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{{familytree | | | B01 | | | | | boxstyle=background: WhiteSmoke| B01= '''Low grade low flow aortic stenosis'''}} | {{familytree | | | B01 | | | | | boxstyle=background: WhiteSmoke| B01= '''Low grade low flow aortic stenosis'''}} | ||
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{{familytree | | | |,|-|^|-|.| | | }} | {{familytree | | | |,|-|^|-|.| | | }} | ||
{{familytree | | | E01 | | E02 | boxstyle=background: WhiteSmoke| E01= Increase in [[stroke volume]] by ≥ 20%| E02= Increase in [[stroke volume]] by <20%}} | {{familytree | | | E01 | | E02 | boxstyle=background: WhiteSmoke| E01= Increase in [[stroke volume]] by ≥ 20%| E02= Increase in [[stroke volume]] by <20%}} | ||
{{familytree | | | |!| | | |!| | | }} | |||
{{familytree | | | F01 | | F02 | boxstyle=background: WhiteSmoke| F01= Presence of left ventricular flow reserve| F02= Absence of left ventricular flow reserve}} | |||
{{familytree | |,|-|^|.| |,|^|-|.| }} | {{familytree | |,|-|^|.| |,|^|-|.| }} | ||
{{familytree | G01 | | G02 | | G03 | boxstyle=background: WhiteSmoke| G01= ΔP≥40 <br> EOA<1-1.2| G02= ΔP<40 <br> EOA≥1-1.2| G03= EOA<1-1.2}} | {{familytree | G01 | | G02 | | G03 | boxstyle=background: WhiteSmoke| G01= ΔP≥40 <br> EOA<1-1.2| G02= ΔP<40 <br> EOA≥1-1.2| G03= EOA<1-1.2}} | ||
Revision as of 13:59, 6 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Management
Shown below is an algorithm of the management of low flow, low gradient aortic stenosis.[1]
| Ultrasound evaluation of aortic stenosis Effective orifice area (EOA)≤ 1 cm2 Pressure gradient (ΔP)<40 mmHg | |||||||||||||||||||||||
| Low grade low flow aortic stenosis | |||||||||||||||||||||||
| Normal left ventricular ejection fraction | Left ventricular ejection fraction≤ 40% | ||||||||||||||||||||||
| No specific recommendations: - Surgical AVR, or - Transcather AVR, or - Medical treatment | |||||||||||||||||||||||
| Dobutamine stress test | |||||||||||||||||||||||
| Increase in stroke volume by ≥ 20% | Increase in stroke volume by <20% | ||||||||||||||||||||||
| Presence of left ventricular flow reserve | Absence of left ventricular flow reserve | ||||||||||||||||||||||
| ΔP≥40 EOA<1-1.2 | ΔP<40 EOA≥1-1.2 | EOA<1-1.2 | |||||||||||||||||||||
| True severe aortic stenosis | Pseudo-severe aortic stenosis | True severe aortic stenosis | |||||||||||||||||||||
| Surgical AVR with/without CABG | Medical treatment Close follow up | Transcather AVR | |||||||||||||||||||||
References
- ↑ Pibarot P, Dumesnil JG (2012). "Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction". J Am Coll Cardiol. 60 (19): 1845–53. doi:10.1016/j.jacc.2012.06.051. PMID 23062546.