Management of low-gradient aortic stenosis

There is an important proportion of patients with significant aortic stenosis who present with low gradient. In clinical practice we distinguish three subpopulations: (1) “classical” type with low left ventricular ejection fraction, (2) paradoxical type with preserved ventricular ejection fraction and (3) patients with normal flow and low gradient. Differentiation between “true” severe aortic stenosis and pseudostenosis by means of low dose dobutamine stress test is sometimes necessary in order to set further management - operative or conservative respectively. Use of other imaging methods such as MSCT proved also valuable. Intervention of severe aortic stenosis in such cases is considered to be superior with regard to survival, though very high operative risk in some subgroups, typically for patients with low ejection fraction, has been reported.