Reverse area and gradient mismatch: The discordance of a large valve area and high gradients

Amr E. Abbas, Steven Jay Lester

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

In previous chapters, we have defined Area gradient match or concordance as present when criteria for AS severity is met by both gradient (ΔP) and area variables. Clinical decision making in these cases is rather straightforward and referral for aortic valve replacement, in the appropriate clinical circumstance, is the rule. Area gradient mismatch was discussed in detail in the previous chapter and refers to the situations where AS is severe by area but not by gradient criteria. Less commonly, and conversely, an elevated gradient may be present across the aortic valve (AV) in the absence of severe decrease in aortic valve area (AVA); and this has been referred to as reverse area gradient mismatch or discordance. This later form of area/gradient severity discordance has not received as much emphasis in the literature as the former and yet maybe present in both native and prosthetic valves (AVprosthesis). In these patients, Doppler-derived gradients and areas may not correspond to those obtained invasively, hence creating a Doppler catheter mismatch which may add further challenges in the appropriate determination of the AS severity. Errors of measurements and assumption, alterations in trans aortic valve flow (Q) and pressure recovery (Prec), and paravalvular obstructions may account for a significant portion of this mismatch phenomenon. Prec may also account for the discrepancy between Doppler- and catheter-derived estimations of AS severity.

Original languageEnglish (US)
Title of host publicationAortic Stenosis: Case-Based Diagnosis and Therapy
PublisherSpringer-Verlag London Ltd
Pages129-145
Number of pages17
ISBN (Print)9781447152422, 9781447152415
DOIs
StatePublished - Jan 1 2015

Keywords

  • Aortic stenosis severity
  • Causes of reverse area/gradient mismatch
  • Doppler/catheter mismatch
  • Eccentric jet
  • Paravalvular obstruction
  • Reverse area/gradient mismatch

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

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    Abbas, A. E., & Lester, S. J. (2015). Reverse area and gradient mismatch: The discordance of a large valve area and high gradients. In Aortic Stenosis: Case-Based Diagnosis and Therapy (pp. 129-145). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-5242-2_9