Preface

Aortic stenosis is the most frequent reason for valvular intervention, and due to an ageing population its incidence is likely to increase. As such, healthcare providers need to be aware of the condition and possess basic knowledge of how to manage it. Echocardiographic assessment of left ventricular outflow gradient and aortic valve area is fundamental for classifying severity of the stenosis. Historically, a surgical approach has been primarily used for treatment, however, a catheter-based approach has emerged as a preferable alternative in many patient subgroups, including those at intermediate and low levels of risk. This book covers diverse aspects of the etiology, diagnosis, treatment, and follow-up of patients with aortic stenosis.

> **Peter Magnusson** Karolinska Institute, Sweden

**1**

**Chapter 1**

Stenosis

*Peter Magnusson*

**2. Diagnostic tools**

**2.1 Echocardiography**

ejection fraction.

evere state.

valve area above 1 cm<sup>2</sup>

**1. Definition and symptoms**

imaging experts, besides cardiologists.

tricular hypertrophy may lead to further investigations.

calcification, and hemodynamic parameters at the time of exam.

• High-gradient aortic stenosis. Here the valve area is <1 cm<sup>2</sup>

Four classes of aortic stenosis can be described:

Introductory Chapter: Aortic

Aortic stenosis is the most frequent cause of valvular intervention in the Western world and is increasing with age. Thus, awareness and basic knowledge about the management of aortic stenosis are important for a diverse spectrum of health-care providers. When a diagnosis of aortic stenosis is established, careful attention and management are warranted by several health-care providers including general practitioners, internists, geriatricians, anesthesiologists, thoracic surgeons, and

Symptoms of aortic stenosis are unspecific and often vague as the disease progression is typically slow. However, when patients finally present with symptoms related to a severe aortic gradient, it may require prompt action. Typically patients with aortic stenosis are limited by shortness of breath at exertion. Because adaptation of lifestyle is common, it is crucial to recognize dyspnea due to aortic stenosis. Sometimes, a dramatic episode like syncope or cardiac arrhythmia occurs. Cardiac auscultation using a stethoscope is common in everyday practice throughout the health-care system, and the presence of a cardiac murmur may suggest an aortic stenosis. The same holds true for echocardiography (ECG), and signs of left ven-

Echocardiography is the cornerstone in identification and follow-up of aortic stenosis. It visualizes the calcification of the aortic valve, and the Doppler technique quantifies the left ventricular outflow gradient [1]. The aortic valve area can be estimated by calculation or planimetry but must be considered in conjunction with the mean gradient, wall thickness, ejection fraction, ventricular dimension, valve

gradient is >40 mmHg. This is clearly a severe aortic stenosis regardless of

with flow normalization is suggestive of pseudos-

• Low-flow, low-gradient aortic stenosis with reduced ejection fraction. Dobutamine echocardiography may be useful in these situations; an aortic

, and the mean
