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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Evaluation and monitoring of asymptomatic adolescents or young adults with aortic stenosis (AS)* Class I - There is evidence and/or general agreement that the following tests should be obtained in asymptomatic adolescents or young adults with AS •  An electrocardiogram and Doppler echocardiography should be obtained yearly in patients who have a Doppler mean gradient >30 mmHg or a peak velocity >3.5 m/sec (peak gradient >50 mmHg), and every two years in patients who have a Doppler mean gradient less than or equal to 30 mmHg or a peak velocity less than or equal to 3.5 m/sec (peak gradient less than or equal to 50 mmHg). •  Cardiac catheterization when the results of Doppler echocardiography are equivocal for the severity of AS or there is a discrepancy about the severity of AS between the clinical and noninvasive findings. •  Cardiac catheterization if the Doppler mean gradient is >30 mm Hg or the peak velocity is >3.5 m/sec (peak gradient >50 mmHg) in asymptomatic patients who develop T wave invasion at rest over the left precordium, or in symptomatic patients (angina, syncope, or dyspnea on exertion). Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following tests in the evaluation of asymptomatic adolescents or young adults with AS •  Graded exercise testing in patients who have a Doppler mean gradient >30 mmHg or a peak velocity >3.5 m/sec (peak gradient >50 mmHg) and want to participate in athletics or have disparate clinical and Doppler findings. •  Cardiac catheterization in patients who have a Doppler mean gradient >40 mmHg or a peak velocity >4.0 m/sec (peak gradient >64 mmHg). •  Cardiac catheterization in patients who have a Doppler mean gradient >30 mmHg or a peak velocity >3.5 m/sec (peak gradient >50 mmHg) and want to participate in athletics or have disparate clinical and Doppler findings. * The gradients are usually obtained with the patient sedated. The gradients may be somewhat lower if general anesthesia is used.

•  Cardiac catheterization in patients who have a Doppler mean gradient >30 mmHg or a peak velocity >3.5 m/sec (peak gradient >50 mmHg) and want to participate in athletics or have disparate clinical and Doppler findings. * The gradients are usually obtained with the patient sedated. The gradients may be somewhat lower if general anesthesia is used. Data from Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.