In patients with normal flow low gradient severe AS, AVR was associated with a significantly improved survival compared with those who received standard medical treatment.

Low-gradient aortic stenosis (AS) [i.e. an aortic valve area (AVA) <1 cm2 with a mean transvalvular gradient <40 mmHg and/or peak jet aortic velocity <4 m/s] is a frequent finding, with up to 40% AS patients harbouring discrepant results at transthoracic echocardiography (TTE) examination.1 This discordant grading pattern raises challenges and uncertainties regarding the true severity of the valve disease. Therefore, a thorough, integrative approach including assessment of flow status has been proposed in recent guidelines

Conclusions The nonprescription drugs loperamide and mitragynine are associated with disproportionate reports of life-threatening ventricular arrhythmia in North America.