Algorithm for the Management of Aortic Stenosis (AS) - Flowchart
Algorithm for the Management of Aortic Stenosis (AS) - Flowchart
«Flowchart»

Severe Aortic Stenosis

Severe Aortic Stenosis

Severe Aortic Stenosis

Severe Aortic Stenosis

Class I

Class I

Class I

Reevaluation
Clinical follow-up, patient education, risk factor modification, annual echo

Reevaluation
Clinical follow-up, patient education, risk factor modification, annual echo

Reevaluation
Clinical follow-up, patient education, risk factor modification, annual echo

Reevaluation
Clinical follow-up, patient education, risk factor modification, annual echo

Vmax > 4 m/s
AVA < 1 cm2
Mean gradient > 40 mmHg

Vmax > 4 m/s
AVA < 1 cm2
Mean gradient > 40 mmHg

Vmax > 4 m/s
AVA < 1 cm2
Mean gradient > 40 mmHg



Undergoing CABG or other heart surgery?

Undergoing CABG or other heart surgery?

Undergoing CABG

Symptoms?

Symptoms?

Symptoms?

Reevaluation

Reevaluation

Reevaluation

Aortic valve replacement

Preoperative coronary angiography

Aortic valve replacement

Preoperative coronary angiography

Aortic valve replacement

Aortic valve replacement

Preoperative coronary angiography

End

End

End

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Class IIb

Class IIb

Class IIb

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Exercise test

Exercise test

Exercise test

Symptoms ↓BP

Symptoms ↓BP

↓ Symptoms <img border="0" src="../V/tu0.gif"></img>BP

Normal

Normal

Normal

LV ejection fraction

LV ejection fraction

LV ejection fraction

Less than 0.50

Less than 0.50

Less than 0.50

Normal

Normal

Normal

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Yes

Yes

Yes

Equivocal

Equivocal

Equivocal

No

No

No

Severe valve calcification, rapid progression, and/or expected delays in surgery

Severe valve calcification, rapid progression, and/or expected delays in surgery

Severe valve calcification, rapid progression, and/or expected delays in surgery

Yes

Yes

Yes

No

No

No

End

End

End