title: [Paradoxical low-flow low-gradient aortic stenosis].
abstract: In approximately one third of patients presenting with suspected severe aortic stenosis, there is a discrepancy between a severely reduced aortic valve opening area (< 1 cm(2)) and a non-severe increase of the mean transvalvular gradient (< 40 mmHg). In a substantial number of these cases there is evidence of a severe paradoxical low-flow low-gradient aortic stenosis, characterized by a reduced stroke volume index in the setting of a normal left ventricular ejection fraction. This finding should trigger an extensive diagnostic work-up, including echocardiography, stress echocardiography and computed tomography to rule out measurement errors and to identify the cause(s) of the hemodynamic discrepancy. If the diagnosis of a severe paradoxical low-flow low-gradient aortic stenosis is confirmed and, furthermore, the patient is normotensive and reports stenosis-associated symptoms, the feasibility of an aortic valve replacement should be considered.
authors.affiliation: Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland. henrik.ten-freyhaus@uk-koeln.de.
authors.forename: H
authors.initials: H
authors.lastname: Ten Freyhaus
authors.affiliation: Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Baldus
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011300:Preoperative Care / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*
keywords: Aortic stenosis, pseudosevere; Aortic valve replacement; Echocardiography; Echocardiography, stress; Stroke volume