Calcific degenerative aortic valve stenosis (AS) is the most common acquired form of heart valve disease that afflicts the elderly population¹ and usually comes to attention when an echocardiogram is ordered to evaluate a systolic murmur in an older subject. As is evident to anyone practicing cardiology these days, the advent of transcatheter aortic valve replacement has focused much attention on the evaluation and optimal treatment of patients with AS. AS often has a long latency period in which symptoms are absent, and, importantly, sudden unexpected cardiac death is rare.^2,3 With symptom onset, survival is markedly reduced without intervention.^4–6 For symptomatic patients with severe AS and normal flow-high gradient characteristics and normal left ventricular ejection fraction (LVEF) (stage D1), aortic valve replacement (AVR) is a class 1 indication. Similarly, for asymptomatic patients with severe AS and LVEF less than fifty percent not because of another cause (stage C2), AVR also is indicated.