Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.
