Dobutamine stress Doppler hemodynamics in patients with aortic stenosis: Feasibility, safety, and surgical correlations

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In selected patients with low-flow/low-gradient AS and LV dysfunction, it may be useful to determine the transvalvular pressure gradient and to calculate valve area during a baseline state and again during exercise or low-dose pharmacological (i.e., dobutamine infusion) stress, with the goal of determining whether stenosis is severe or only moderate in severity (123,(141)(142)(143)(144)(145)(146)(147). Such studies can be performed in the echocardiography laboratory or in the cardiac catheterization laboratory.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…140 In selected patients with low-flow/low-gradient AS and LV dysfunction, it may be useful to determine the transvalvular pressure gradient and to calculate valve area during a baseline state and again during exercise or low-dose pharmacological (i.e., dobutamine infusion) stress, with the goal of determining whether stenosis is severe or only moderate in severity. 123,[141][142][143][144][145][146][147] Such studies can be performed in the echocardiography laboratory or in the cardiac catheterization laboratory. This approach is based on the notion that patients who do not have true anatomically severe stenosis will exhibit an increase in the valve area and little change in gradient during an increase in stroke volume.…”

Use of levosimendan in critically ill patients with severe aortic stenosis and left ventricular dysfunction

“…4 Traditionally, drugs with vasodilator properties have been contra-indicated in severe AS 5 because of concern that they may precipitate life-threatening hypotension. Recently, this concept has been challenged in the UNLOAD study, 6 which showed for the first time that the administration of nitroprusside to patients with severe AS and severe LV dysfunction dramatically improved cardiac output, providing an effective bridge to AVR or oral vasodilator therapy.…”

“…4 In Case 1 we were faced with this differential diagnosis since after successful cardioversion the patient persisted with reduced LVEF. Levosimendan was our option due to its long-lasting positive effects on myocardial function and coronary blood flow.…”

“…However, it is contraindicated if there is coronary artery disease (CAD), since it may induce arrhythmias and myocardial ischemia. 4 While drugs with vasodilator effects have traditionally been contraindicated in severe AS, 5 this concept has recently been challenged, as sodium nitroprusside has been shown to have beneficial hemodynamic effects in severe decompensated AS, providing an effective bridge to AVR or oral vasodilator therapy. 6 However, nitroprusside's narrow therapeutic window and possibility of triggering cardiac ischemia mandates caution.…”