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Low flow -Low gradient Aortic stenosis : Clarity replaced with confusion !

Posted Feb 27 2011 5:09am

New concepts are created to clear confusion and bring clarity. We know all along low gradient AS is a hall mark of severe LV dysfunction. Now we suddenly invented normally contracting  LV can also cause  low gradient due to low flow when the aortic valve orifice becomes very critically narrow .

How can it occur ?  . . . few  suspect  it  to be  semantics  !

The terminology  that is  often used in recent times when describing severe aortic stenosis.This is called Low gradient severe AS with preserved LV function .

But logic would say blood flow is required to produce gradient .If it falls extremely low the gradient is likely to fall.

If that is the case every severe  AS patient will experience low flow at least in  few beats . Is this the reason why we find it very difficult to reproduce the exact gradient  ?

Low flow ,Low gradient aortic stenosis is not a  new entity .It is the way we look at the data. It  remains a fact  ,  severe  AS can be diagnosed with 2D features alone ,  without the help of Doppler.We also know  Doppler is less reliable than 2D in many situations for various  reasons .The most important being it’s dependence on angle of  doppler  intercept  and LV contractile force.

Read  the  argument by   Nikolaus Jander from Germany


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