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Heart valve disease (aortic valve disease): aortic stenosis 

Heart valve disease (aortic valve disease): aortic stenosis
Chapter:
Heart valve disease (aortic valve disease): aortic stenosis
Author(s):

Helmut Baumgartner

, Stefan Orwat

, Elif Sade

, and Javier Bermejo

DOI:
10.1093/med/9780198726012.003.0032
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date: 23 September 2020

Echocardiography has become the gold standard for the assessment of patients with aortic stenosis (AS). It allows morphological assessment of the aortic valve and provides information on the aetiology of the disease. The quantification of AS includes primarily the measurement of transaortic jet velocities and gradients as well as the calculation of the valve area, thus combining flow-dependent and relatively flow-independent variables. Awareness of potential pitfalls is fundamental when assessing these variables. Haemodynamic consequences of AS on left ventricular (LV) size, wall thickness, and function as well as associated valve lesions and estimates of pulmonary artery pressure are required for the comprehensive evaluation of the disease. In the setting of classical low-flow–low-gradient AS with reduced LV systolic function, low-dose dobutamine echocardiography is of particular diagnostic and prognostic importance. The entity of severe low-flow–low-gradient AS in the presence of preserved LV function remains a particular diagnostic challenge. For accurate differentiation from pseudo-severe AS or misclassified moderate AS, an integrated approach including additional variables such as the extent of valve calcification by computed tomography may be required. In addition to the assessment of AS aetiology and quantification of its severity, echocardiography can provide predictors of outcome that may have a major impact on the decision for intervention.

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