Aortic Stenosis Grading — FRCA Final MCQ

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ModeratePreoperative AssessmentAortic Stenosis GradingFRCA Final

A 74-year-old woman (ASA III) awaiting fixation of a hip fracture is found to have a previously undocumented ejection systolic murmur at preoperative assessment. Transthoracic echocardiography reports normal left ventricular function with normal transvalvular flow, a peak aortic jet velocity of 3.4 m/s, a mean transvalvular gradient of 30 mmHg and an aortic valve area of 1.3 cm². How should the severity of her aortic stenosis be classified?

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Correct answer: B — Moderate aortic stenosis

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

C is correct. In normal-flow conditions, moderate aortic stenosis is defined by peak velocity 3.0–3.9 m/s, mean gradient 20–39 mmHg and valve area 1.0–1.5 cm²; her values of 3.4 m/s, 30 mmHg and 1.3 cm² are concordant and all lie in that band. B (mild) fails because mild disease requires velocity below 3 m/s, mean gradient under 20 mmHg and area above 1.5 cm²; candidates often misclassify by anchoring on the modest gradient alone. D (severe) requires velocity ≥4 m/s, mean gradient ≥40 mmHg or area ≤1.0 cm², and E (very severe, velocity ≥5 m/s) is further from the data. A is excluded by an abnormal velocity and reduced valve area. Note that mean, not peak, gradient is the grading variable, and low-flow states can mask severe disease.

Reference: Tastet L et al. Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis. J Am Heart Assoc, 2024 — https://pubmed.ncbi.nlm.nih.gov/39023065/ (severity bands compatible with NICE NG208, 2021: https://www.nice.org.uk/guidance/ng208/chapter/recommendations)