Intervention is indicated in symptomatic severe high gradient aortic stenosis with:
Correct answer: d) Mean gradient 40 mm Hg or more OR peak velocity 4 m/s or more
Severe aortic stenosis can also exist with a low mean gradient below 40 mm Hg. In such cases, usually there is associated left ventricular dysfunction so that left ventricle is unable to produce sufficient force to generate the high gradient. Before intervention is contemplated in such cases, left ventricular contractile reserve should be documented as improvement in stroke volume with dobutamine infusion.
Pseudo severe aortic stenosis can also be there when the measured valve area is low because of low cardiac output which prevents proper opening of the valve leaflets due to low stroke volume. In this case the measured valve area increases above 1 sq cm with dobutamine infusion.
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