Abstract
While the clinical severity of aortic stenosis (AS) is based largely on symptoms, indications for surgical aortic valve replacement (SAVR) and/or transcutaneous (TAVR) rely upon calculated estimates of the hemodynamic significance and degree of valvular stenosis. Severe AS is defined as an aortic valve area (AVA) <1.0 cm2 or indexed AVA <0.6 cm2/m2, mean trans-valvular pressure gradient (∆P) >40 mmHg, and/or peak trans-aortic velocity >4 m/s by Doppler echocardiography. Whether the above conditions must be met individually or collectively remains unclear. As noted, “area/gradient match” occurs when both the AVA and ∆P fall within the severe range. This may occur regardless of the presence of normal or abnormal ejection fraction and regardless of the presence or absence of low flow (defined as a stroke volume index on echocardiography <35 ml/m2). However, the AVA may be in the severe range, while the gradient may be in the non-severe range. This has been referred to as area/gradient mismatch and will be discussed further in this chapter.
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Franey, L.M., Lester, S.J., Wood, F.O., Abbas, A.E. (2015). Area and Gradient Mismatch: The Discordance of a Small Valve Area and Low Gradients. In: Abbas, A. (eds) Aortic Stenosis. Springer, London. https://doi.org/10.1007/978-1-4471-5242-2_8
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DOI: https://doi.org/10.1007/978-1-4471-5242-2_8
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