<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-5633</journal-id>
<journal-title><![CDATA[Revista Colombiana de Cardiología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Colomb. Cardiol.]]></abbrev-journal-title>
<issn>0120-5633</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Colombiana de Cardiologia. Oficina de Publicaciones]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-56332017000100048</article-id>
<article-id pub-id-type="doi">10.1016/j.rccar.2016.05.009</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Estenosis aórtica severa de bajo flujo, bajo gradiente con función sistólica preservada, un reto diagnóstico y terapéutico: ¿qué sabemos a día de hoy?]]></article-title>
<article-title xml:lang="en"><![CDATA[Low-flow, low-gradient severe aortic stenosis with preserved systolic function, a diagnostic and therapeutic goal: What do we know today?]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Erdociaín Perales]]></surname>
<given-names><![CDATA[Mar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zuazola Martínez]]></surname>
<given-names><![CDATA[Pilar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cay Diarte]]></surname>
<given-names><![CDATA[Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital de la Marina Baixa  ]]></institution>
<addr-line><![CDATA[Villajoyosa ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Miguel Servet  ]]></institution>
<addr-line><![CDATA[Zaragoza ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<volume>24</volume>
<numero>1</numero>
<fpage>48</fpage>
<lpage>55</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-56332017000100048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-56332017000100048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-56332017000100048&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen La estenosis aórtica severa de flujo bajo, gradiente bajo y la fracción de eyección del ventrículo izquierdo conservada es una entidad frecuente en la práctica clínica. Probablemente, represente una fase más avanzada de la enfermedad con una mayor carga soportada o de más larga data y con una fisiopatología restrictiva. Existen características clínicas, hemodinámicas y ecocardiográficas típicas. Se trata de una entidad infradiagnosticada y como consecuencia infratratada con un claro peor pronóstico con tratamiento conservador. Se necesita en muchos casos el apoyo de la «multiimagen» para un adecuado diagnóstico y elección del momento terapéutico. La sustitución valvular en los pacientes con estenosis aórtica severa y flujo bajo paradójico, parecen tener una mayor mortalidad a corto y largo plazo al compararla en los pacientes con flujo normal y similar si lo hacemos frente a la estenosis aórtica de bajo flujo y fracción de eyección del ventrículo izquierdo deprimida. Existe una menor mortalidad con la implantación transcatéter de válvula aórtica comparándolo frente al tratamiento médico en pacientes con estenosis aórtica severa sintomática con flujo bajo, tanto la fracción de eyección baja como el flujo bajo paradójico, considerados inoperables. No parecen existir evidencias actuales para recomendar el abordaje percutáneo frente al recambio valvular aórtico quirúrgico en los pacientes de alto riesgo quirúrgico con estenosis aórtica con flujo bajo paradójico.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Low-flow, low-gradient severe aortic stenosis with preserved ejection fraction of the left ventricle is a frequent entity of clinical practice. It can probably represent a more advance phase of the illness with a heavier load or time frame and a restrictive pathophysiology. There are typical clinical, hemodynamic and echocardiographic characteristics. It is an underdiagnosed condition, and as such it is undertreated, with a clearly worse prognosis with conservative treatment. In many cases, the help of «multiimaging» is required for an appropriate diagnosis and choosing the therapeutic moment. Valve replacement in patients with paradoxical low-flow, low-gradient severe aortic stenosis seem to show higher mortality in the short and long term when compared to patients with normal flow, and similar mortality if compared to low-flow aortic stenosis with depressed ejection fraction of the left ventricle. There is a lower mortality with the transcatheter aortic valve implantation in comparison with treatment of patients with symptomatic low-flow severe aortic stenosis, both for a low ejection fraction and for the paradoxical low flow, considered inoperable. No current evidence seems to exist to recommend percutaneous approach versus aortic valve replacement in high surgical risk patients with aortic stenosis with paradoxical low flow severe aortic stenosis.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Estenosis aórtica severa]]></kwd>
<kwd lng="es"><![CDATA[Bajo flujo paradójico]]></kwd>
<kwd lng="es"><![CDATA[Fracción eyección conservada.]]></kwd>
<kwd lng="en"><![CDATA[Severe aortic stenosis]]></kwd>
<kwd lng="en"><![CDATA[Paradoxical low flow]]></kwd>
<kwd lng="en"><![CDATA[Preserved ejection fraction]]></kwd>
</kwd-group>
</article-meta>
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