Severe Aortic Stenosis

In this article, we will discuss Severe Aortic Stenosis (Definition). So, let’s get started.

Definition

According to the American Heart Association (AHA)/ACC Guidelines for the Management of Patients with Valvular Heart Disease, which was updated most recently in 2014, severe AS is broken down into three stages: D1, D2, and D3. Patients must qualify for one of these three stages to be considered for TAVR.

Stage D1 Severe Aortic Stenosis

Stage D1 AS is defined as “severe symptomatic severe high-gradient AS.” Echocardiographic valve anatomy findings reveal leaflet calcification with reduced leaflet motion. Hemodynamic findings of the aortic valve typically reveal an aortic valve area of less than or equal to 1.0 cm (may be larger with mixed AS/aortic regurgitation), an aortic Vmax of greater than 4.0 m/s, or a mean gradient greater than or equal to 40 mm Hg.

Stage D2 Severe Aortic Stenosis

Stage D2 AS is defined as “symptomatic severe low-flow/low-gradient AS with reduced LVEF less than 50%. Echocardiographic valve anatomy findings reveal leaflet calcification with reduced leaflet motion. Hemodynamic findings of the aortic valve typically show an aortic valve area of less than or equal to 1.0 cm with a resting aortic Vmax less than 4.0 m/s or mean gradient less than 40 mm Hg. Dobutamine stress echocardiogram shows aortic valve area less than or equal to 1.0 cm² and an aortic Vmax greater than or equal to 4.0 m/s or a mean gradient greater than or equal to 40 mm Hg at any flow rate of dobutamine.

Stage D3 Severe Aortic Stenosis

Stage D3 AS is defined as “symptomatic severe low-gradient AS with normal LVEF ≥50%. Echocardiographic valve anatomy findings reveal leaflet calcification with reduced leaflet motion. Hemodynamic findings of the aortic valve show an aortic valve area of less than or equal to 1.0 cm with an aortic Vmax less than or equal to 4 m/s or mean gradient less than or equal to 40 mm Hg and an indexed stroke volume of less than 35 mL/m².