Sandbox Rim

Abnormal aortic valve AND Reduction in systolic opening

Severe aortic stenosis Vmax ≥4m/s ΔPmean ≥40 mmHg

Vmax 3-3.9 m/s ΔPmean 20-39 mmHg

Is the patient symptomatic?

Is the patient symptomatic?

Yes, the patient is symptomatic (Stage D1)

No, the patient is not symptomatic (Stage C)

Yes, the patient is symptomatic

No, the patient is not symptomatic (Stage B)

LVEF <50% (Stage C2)

Is LVEF <50%?

The patient is undergoing cardiac surgery

The patient is undergoing cardiac surgery (Stage C1)

Yes

No

Vmax ≥5m/s ΔPmean ≥60 mmHg (Very severe stage C1) AND Low surgical risk

Abnormal exercise treadmill test (Stage C1)