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AS Surveillance Frequency — EECC MCQ

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EasyValvular Heart DiseaseAS Surveillance FrequencyEECC

A 60-year-old man with known bicuspid aortic valve and moderate AS presents with progressive exertional dyspnoea. His echocardiogram shows a peak velocity of 3.8 m/s, mean gradient 30 mmHg, and AVA 1.1 cm². He has significant calcification of the raphe. How frequently should echocardiographic surveillance be performed?

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Correct answer: E — Moderate AS: annual echocardiography to detect progression; more frequently if approaching severe thresholds or if rapid progression suspected (bicuspid valves may calcify rapidly)

The 2025 ESC/EACTS VHD Guidelines recommend echocardiographic surveillance intervals based on AS severity: (1) Mild AS (Vmax 2.0-2.9 m/s): every 2-3 years; (2) Moderate AS (Vmax 3.0-3.9 m/s): every 1-2 years; (3) Severe asymptomatic AS: every 6-12 months. Bicuspid aortic valves may progress more rapidly than tricuspid valves due to abnormal haemodynamic stress on the raphe, and patients with heavy raphe calcification may progress faster. Additional parameters to monitor include: LVEF, LV dimensions, PASP, and ascending aortic diameter. Any change in symptoms should prompt urgent reassessment. Exercise testing may be considered in asymptomatic severe AS to unmask symptoms.

Reference: ESC/EACTS (2025): VHD Guidelines