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Introduction  Since many patients with AVA   40 mmHg, we sought to determine the AVA at which mAVG tends to exceed 40 mmHg in a sample of subjects with varied transvalvular flow rates.    Material and methods  We selected 200 subjects with an AVA  40 mmHg at a wide range of MSF. In contrast, those with severe AVA typically (75%) had mAVG &gt; 40 mmHg when MSF was normal (&gt;200 ml/s).  Those with critical AVA frequently (44%) had mAVG &gt; 40 mmHg, even when MSF was reduced.    Conclusions  AVA &gt; 0.8 cm2 was rarely associated with mAVG &gt; 40 mmHg, even when transvalvular flow rate was normal. Consideration should therefore be given to either raising the cutoff AVA or lowering the mAVG at which aortic stenosis is considered severe.

At what flow rate does aortic valve gradient become severely elevated? Implications for guideline recommendations on aortic valve area cutoffs