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Severe Symptomatic AS — RACP Adult Medicine MCQ

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EasyCardiologySevere Symptomatic ASRACP Adult Medicine

A 70-year-old man presents with exertional syncope, angina, and dyspnoea. Examination reveals a slow-rising pulse, narrow pulse pressure, and a loud ejection systolic murmur radiating to the carotids. Echo shows severe aortic stenosis (AVA 0.8 cm², mean gradient 50 mmHg, peak velocity 4.5 m/s) with LVEF 55%. What is the most appropriate management?

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Correct answer: E — Surgical aortic valve replacement (SAVR)

Severe symptomatic aortic stenosis (AVA <1.0 cm², mean gradient >40 mmHg, Vmax >4 m/s) with symptoms (syncope, angina, dyspnoea — SAD) requires intervention. For patients <75 with low surgical risk, SAVR remains the standard. For patients ≥75 or high surgical risk, TAVI is preferred (PARTNER 3, Evolut Low Risk trials showed non-inferiority of TAVI to SAVR even in low-risk patients). Without intervention, symptomatic severe AS has 50% 2-year mortality.

Reference: CSANZ – 2024 – Valvular Heart Disease; ESC 2021 VHD