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Aortic valve area: too important for splendid isolation
  1. Jan Minners
  1. Department of Cardiology, University Heart Center Freiburg, Bad Krozingen, Germany
  1. Correspondence to Dr Jan Minners, Department of Cardiology, University Heart Center Freiburg, Bad Krozingen, 79189, Germany; Jan.Minners{at}universitaets-herzzentrum.de

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Echocardiography is the key diagnostic modality for the assessment of aortic stenosis (AS) with a number of parameters available to estimate stenosis severity. Morphological criteria including calcification and reduced leaflet mobility are supplemented by flow dependent (jet velocity and mean pressure gradient) and largely flow-independent parameters (aortic valve area, aortic valve area index and velocity ratio).1 2 In the majority of patients, consistent results regarding stenosis severity will be obtained over the range of parameters. However, depending on the population under study, up to 30% of patients will demonstrate discrepant stenosis severity between flow-dependent (eg, mean pressure gradient) and flow-independent (aortic valve area) markers, with the latter commonly indicating a higher grade stenosis.3

Two developments over the last decades have augmented the problem of discrepant stenosis severity. First, there has been a trend in guidelines towards easing the partition values for the assessment of AS severity with an emphasis on aortic valve area .1 2 The threshold for severe stenosis according to mean pressure gradient moved from 50 mm Hg to 40 mm Hg and according to aortic valve area from <0.8 cm2 to <1 cm2 (with an often unrecognised twitch from <1 to ≤1 cm …

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