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Physiological Basis for Area and Gradient Assessment: Hemodynamic Principles of Aortic Stenosis

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Aortic Stenosis

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Abstract

The clinical syndrome of severe aortic stenosis (AS) is primarily diagnosed by a mean trans-valve pressure gradient (∆Pmean) >40 mmHg, an aortic valve area (AVA) <1 cm2, AVA indexed to BSA <0.6 cm2/m2, and/or a maximum transaortic velocity (AVVel) >4 m/s with or without symptoms. Surgical or transcatheter aortic valve replacement for symptomatic, severe AS results in significant improvement in survival and quality of life across a spectrum of surgical risk profiles. However, invasive treatments for non-severe AS have not demonstrated similar benefits, and may subject patients to unnecessary procedural risk. Therefore, precise quantification of AS severity is of paramount importance. Notwithstanding, it remains unclear whether area and gradient criteria have to present collectively or individually, or whether they must be obtained invasively or by Doppler.

In this chapter, we will review the physiological changes that occur as blood flow approaches the stenotic aortic valve with generation of a transvalvular ∆P, the relationship between AVA and ∆P, the determinants of transvalvular ∆P and AVA, and the role of Doppler and cardiac catheterization in assessing the severity of aortic stenosis.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Beaumont Health, Oakland University/William Beaumont School of Medicine, Royal Oak, MI, USA

    Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI

  2. Department of Research, Quebec Heart and Lung Institute, Quebec City, QC, Canada

    Philippe Pibarot DVM, PhD, FAHA, FACC, FESC, FASE

Authors
  1. Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI
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  2. Philippe Pibarot DVM, PhD, FAHA, FACC, FESC, FASE
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Correspondence to Amr E. Abbas MD,FACC,FSCAI,FSVM,FASE,RPVI .

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Editors and Affiliations

  1. Interventional Cardiology Research, Beaumont Health System, Royal Oak, Michigan, USA

    Amr E. Abbas

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Abbas, A.E., Pibarot, P. (2015). Physiological Basis for Area and Gradient Assessment: Hemodynamic Principles of Aortic Stenosis. In: Abbas, A. (eds) Aortic Stenosis. Springer, London. https://doi.org/10.1007/978-1-4471-5242-2_3

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  • DOI: https://doi.org/10.1007/978-1-4471-5242-2_3

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5241-5

  • Online ISBN: 978-1-4471-5242-2

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