Paradoxical low-flow aortic valve stenosis is defined as the presence of small valve area (c/w severe Aortic stenosis), low transvalvular gradients (non -severe range) in the presence of low transvalvular flow, but with normal ejection fraction (>50%). This discordant echocardiographic data creates doubts about the severity of the disease. Depending on various reports from the literature, the prevalence rate of this condition may range anywhere from 3% to 35% of all cases of severe aortic valve stenosis. Among this population of low flow, low gradient, normal EF and severe aortic valve stenosis, there is an unknown percentage of cases that are not ‘truly severe’ and approach to this clinical population is challenging. The diagnosis of this condition is evolving as the therapeutic approaches. Many retrospective, non-randomized publications have shown that there is a possible clinical benefit from aortic valve replacement. Due to the high prevalence of aortic stenosis in any cardiology practice, and the implications of the diagnosis and management of severe aortic stenosis, we outline current trends in the diagnosis and treatment of this entity.