Paradoxical Low Flow Low Gradient Severe Aortic Stenosis—An Under-Recognized Entity

Some patients with severe aortic stenosis (AS), due to restrictive cardiac physiology, paradoxically have relatively low flow and gradients across stenotic valves despite preserved left ventricular (LV) systolic function. It results in symptoms reduced quality of life carries a high mortality. Whilst this form AS, termed paradoxical gradient (pLFLG), is well reported, diagnosis experience inappropriate barriers valve replacement (AVR), the only efficacious treatment. We present case an 88-year-old female 12 months exertional dyspnoea on background hypothyroidism hypercholesterolemia. Transthoracic echocardiogram (TTE) revealed LV hypertrophy, small cavity size stroke volume, yet normal A heavily calcified was identified stenosis, based area, incongruous mean transvalvular 25 mmHg (severe ≥ 50 mmHg). Following exclusion other differential diagnoses, her were attributed LFLG AS. She however declined definitive transcatheter implantation (TAVI) gradient. further deterioration supportive quantification poor exercise performance, she ultimately re-referred, accepted, underwent TAVI. AVR, patient experiences significant improvement both after one month. Paradoxical AS remains well-documented under recognized disease. morbidity mortality if untreated, significantly less likely be referred accepted for intervention. With its prevalence expected rise ageing population, serves as timely reminder clinicians address recognition important pathology.