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Archives of cardiovascular diseases
Volume 106, n° 4
pages 261-262 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.045
Survey on practices: Severe aortic stenosis and new syndromes of paradoxical low gradient aortic stenosis

S. Mouton, D. Montaigne, M. Richardson, A.-S. Polge
 CHRU de Lille, Lille, France 

Objectives .– Paradoxical low gradient aortic stenosis is a new entity for which the optimal management approach remains debated. The aim of the study was to show the heterogeneity of practices due to the lack of recommendations concerning the management of patients having an aortic stenosis.

Methods .– From June to November 2012, a survey was conducted in all graduated cardiologists of the “Nord-Pas-de-Calais” region (France). A multiple-choice test was performed concerning the exploration and management of patients having a severe aortic stenosis. They were asked about examinations made in routine and proposed treatments through brief clinical cases with echocardiographic data.

Results .– Three hundred and thirteen cardiologists were surveyed. The exercise test was retained by 52.7% of the practitioners for the asymptomatic severe aortic stenosis to unmask symptoms. According to guidelines, 91.4% of the cardiologists proposed surgical treatment for the symptomatic severe aortic stenosis; 81.5% of the practitioners performed a stress echocardiography using Dobutamine for patients having a low gradient aortic stenosis with a depressed left ventricular function to differentiate a true severe aortic stenosis and a pseudosevere aortic stenosis. Surgical treatment was considered in 58.9% of cases for patients having a paradoxical low flow – low gradient aortic stenosis and in only 22.8% of cases for the normal flow – low gradient aortic stenosis, for which cardiologists chose to perform other investigations in a first time.

Conclusion .– Contrary to normal flow/low gradient, paradoxical low flow/low gradient aortic stenosis was complementary explored in less than one third of cases and proposed examinations were often inappropriate.

© 2013  Published by Elsevier Masson SAS.
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