The management of patients with severe symptomatic aortic stenosis and a high transvalvular gradient is straightforward.It requires aortic valve replacement.Management of aortic stenosis patients with low flow,low ejection fraction and low gradient is fraught.Such patients rarely fulfi ll all the tenets of“severity”and also have severe left ventricular dysfunction.Both circumstances make the outcome of aortic valve replacement uncertain.Thus the management of this group of patients requires integration of all diagnostic modalities available.The physical examination,degree of valve calcification,the appearance of the valve during sonographic examination and the presence of inotropic reserve all contribute importantly in judging stenosis severity and the likelihood of successful valve replacement.
展开▼
