Stress echocardiography in low flow, low gradient aortic stenosis with deteriorated systolic function

Echocardiography  Favaloro Foundation. Buenos Aires, Argentina. JACC Cardiovascular Imaging has recently published a retrospective analysis including severe aortic stenosis patients (< 1 cm²), with low gradient (mean aortic gradient Patients that had undergone dobutamine stress echocardiography (DSE) to distinguish pseudo aortic stenosis (n=49) were selected. These results were used to determine flow reserve (FR). The<a href="https://solaci.org/en/2014/12/18/stress-echocardiography-in-low-flow-low-gradient-aortic-stenosis-with-deteriorated-systolic-function/" title="Read more" >...</a>

Flow-Gradient Patterns can help in the selection of patients with aortic stenosis

Original title: Flow-Gradient Patterns in Severe Aortic Stenosis UIT Preserved Ejection Fraction. Clinical Characteristic and Predictos of Survival. Reference: Eleid, M, et al. Circulation 2013;128:1781-1789 Severe aortic stenosis is usually defined by echocardiography as a 40 mm mean transvalvular gradient Hg at >4 m/s; but there are low flow or paradoxical low flow cases with different evolution. 1704<a href="https://solaci.org/en/2013/10/22/flow-gradient-patterns-can-help-in-the-selection-of-patients-with-aortic-stenosis/" title="Read more" >...</a>

Low Gradient Severe Aortic Stenosis despite Preserved Ejection Fraction

Original title: Invasive Hemodynamic Characteristics of Low Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction. Reference: Juliane Lauten et al. J Am Coll Cardiol 2013;61:1799–808. Although the pathophysiology, clinical features, and natural course of severe aortic stenosis have been extensively described, management recommendations are still evolving. The current European and American guidelines recommend a valve area cutoff of<a href="https://solaci.org/en/2013/05/09/low-gradient-severe-aortic-stenosis-despite-preserved-ejection-fraction/" title="Read more" >...</a>

¿Cómo objetivar la fragilidad en pacientes con estenosis aórtica?

Aortic Stenosis Progression Evolution

Aortic stenosis is an increasingly common valvulopathy because people are living longer now. A present, the main treatment consists of surgical (SAVR) or transcatheter aortic valve replacement. (TAVR). One of the main challenges of this disease is its progression. The European guidelines recommend Doppler echocardiograms every 2 to 3 years for mild cases, mildly calcified,<a href="https://solaci.org/en/2024/05/15/aortic-stenosis-progression-evolution/" title="Read more" >...</a>

ACC 2024 | DEDICATE Trial: Transcatheter or Surgical Treatment of Aortic Valve Stenosis

In recent years, TAVR has been increasingly used; however, when it comes to younger, lower risk patients, its use is still challenged.  In this context, there is limited information and we lack randomized studies on “real world” cohorts.  The DEDICATE randomized 1.414 patients over 65 with severe symptomatic aortic stenosis. 701 of these patients received<a href="https://solaci.org/en/2024/04/11/acc-2024-dedicate-trial-transcatheter-or-surgical-treatment-of-aortic-valve-stenosis/" title="Read more" >...</a>

El estudio CULPRIT-SHOCK finalmente se publica en el NEJM y llega para cambiar las guías

Aortic Stenosis and Cardiogenic Shock: Is TAVR an Option?

Cardiogenic shock (CS) in a setting of aortic stenosis is associated with high mortality rates. In consequence, surgery is generally not a possibility for this patient group, and they usually undergo aortic valvuloplasty, resulting in a mortality rate of 33%-50% at 30 days, 70% at one year, and 90% at two years. While transcatheter aortic<a href="https://solaci.org/en/2023/07/04/aortic-stenosis-and-cardiogenic-shock-is-tavr-an-option/" title="Read more" >...</a>

EuroPCR 2023 | TAVR in Patients with Bicuspid Aortic Valve Stenosis

Bicuspid aortic valve (BAV) stenosis is the most common congenital valve disease, affecting up to 2% of the population. Patients with BAV disease undergoing transcatheter aortic valve replacement (TAVR) account for 0.5%. In this context, TAVR data on BAV stenosis patients has been limited to observational studies on first generation valves that had resulted in<a href="https://solaci.org/en/2023/05/21/europcr-2023-tavr-in-patients-with-bicuspid-aortic-valve-stenosis/" title="Read more" >...</a>

Aortic Stenosis and Dialysis: Is TAVR the Strategy of Choice?

Courtesy of Dr. Carlos Fava. TAVR has been shown beneficial in high and moderate risk patients, but there is a group of patients that require dialysis on account of kidney deterioration. This comorbidity is due to bad cardiovascular evolution associated to diabetes, bleeding and thromboembolic events.   For some time, we have been using an<a href="https://solaci.org/en/2018/12/03/aortic-stenosis-and-dialysis-is-tavr-the-strategy-of-choice/" title="Read more" >...</a>

$Masa miocárdica fraccional para evaluar la severidad de la estenosis$

Aortic Stenosis with Normal Flow Low Gradient: Should We Intervene or Wait?

Symptomatic patients with <1 cm² aortic valve area will benefit from an intervention regardless parameters such as flow and gradient, even if these are normal (or at least not severe). A valve replacement will be indicated without question (either surgical or percutaneous) in patients with >40 mHg mean gradient or low gradient justified by low<a href="https://solaci.org/en/2018/09/27/aortic-stenosis-with-normal-flow-low-gradient-should-we-intervene-or-wait/" title="Read more" >...</a>

Enfermedades malignas y estenosis aórtica ¿Se justifica el TAVI?

Gradient vs. Flow to Determine Aortic Valve Stenosis Severity before and after TAVR

Pressure loss vs. flow curves offer a fundamental synthesis of fluids dynamics in describing aortic valve physiopathology. Severe aortic stenosis is not just an orifice (as suggested by Gorlin) or a segment that offers dynamic resistance. However, once a new transcatheter valve has been implanted, it will behave purely as a resistor. At dobutamine dose,<a href="https://solaci.org/en/2018/08/15/gradient-vs-flow-to-determine-aortic-valve-stenosis-severity-before-and-after-tavr/" title="Read more" >...</a>