Paradoxical Low flow-Low gradient- Aortic stenosis: What is the paradox & why does it happen?

Aortic stenosis evaluation was so simple in our early days. Gradients across the valve were the key. Now, we have more parameters to bother about. Dynamic AVOs, flow state, resting LV function, contractile reserves, GLS, dobutamine response, etc. MRI assessment will soon overtake echocardiography.  Hemodynamics of flow across LVOT. MRI 4D volumetric model of normal Aortic stenotic flow in the bicuspid valve (On the left). The more we know, the more we tend to miss! Image courtesy: Northwestern Medicine The current AS algorithms, though scientific, I am afraid, appear much complicated with some frightening terminologies at least for the beginner. One such category is PLF-LG-AG. Let us first answer this. What is LG-AS? We diagnose a case of significant Aortic stenosis but desperately missing to pick an adequate gradient across the valve. It is indeed a low gradient, still, you are not convinced, since the 2D look of the valve looks severe. Then you find the culprit. It is the dysfunctional ventricle pulling down the gradient. This is called  LG-AS.(one type ) *What is paradoxical -Low flow-Low gradient Aortic stenosis? (PLF-LG AS) Now, we have another patient. It is indeed LG-AS, but the LV function and EF are normal. You get confused and label it as PLF-LG-AS.  PLF-LG AS is known to account for approximately one-third of patients with severe AS and preserved LV EF.PLF-LG severe AS is defined by AVA <1.0 cm2, indexed AVA <0.6 cm2/m2, mean gradien...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Aortic diseases aortic stenosis amyloidosis in aortic stenosis ASE ACC AHA ESC guidelines for aortic stenosis dobutamine stress in aortic stenosis doppler error in aortic stenosis grading severity of aortic stenosis hypertension and aortic s Source Type: blogs