**6. Conclusion**

Clinicians should be mindful that patients with symptomatic severe AS may well have low flow and thereby low gradient. Occasionally symptoms may represent severity of underlying heart failure rather than the severity of AS. Established minimally invasive trans-catheter therapies, although has improved associated morbidities of SAVR for intermediate and high-risk patients, it is important that treatment is directed to those who will benefit the most. Accurate diagnosis of severe AS is important as treatment modalities and its timing can offer prognostic benefits in the immediate and long term.

## **Conflict of interest**

Faeez Mohamad Ali and Vindhya Wilson—no conflict of interest. Rajesh Nair—proctor for Medtronic.
