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Arteriosclerosis, Thrombosis, and... Apr 2020Aortic valve stenosis is the most prevalent heart valve disease worldwide. Although interventional treatment options have rapidly improved in recent years, symptomatic... (Review)
Review
Aortic valve stenosis is the most prevalent heart valve disease worldwide. Although interventional treatment options have rapidly improved in recent years, symptomatic aortic valve stenosis is still associated with high morbidity and mortality. Calcific aortic valve stenosis is characterized by a progressive fibro-calcific remodeling and thickening of the aortic valve cusps, which subsequently leads to valve obstruction. The underlying pathophysiology is complex and involves endothelial dysfunction, immune cell infiltration, myofibroblastic and osteoblastic differentiation, and, subsequently, calcification. To date, no pharmacotherapy has been established to prevent aortic valve calcification. However, novel promising therapeutic targets have been recently identified. This review summarizes the current knowledge of pathomechanisms involved in aortic valve calcification and points out novel treatment strategies.
Topics: Animals; Aortic Valve Stenosis; Cell Communication; Cell Differentiation; Cells, Cultured; Disease Models, Animal; Endothelium, Vascular; Humans; Inflammation; Lipoproteins; Myofibroblasts; Osteoblasts; Osteoclasts; RNA, Untranslated; Vascular Calcification
PubMed: 32160774
DOI: 10.1161/ATVBAHA.119.313067 -
American Family Physician Mar 2016Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it... (Review)
Review
Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it decreases rapidly after symptoms appear. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients. However, select patients may also benefit from aortic valve replacement before the onset of symptoms. Surgical valve replacement is the standard of care for patients at low to moderate surgical risk. Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk. Patients should be educated about the importance of promptly reporting symptoms to their physicians. In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. Cardiology referral is recommended for all patients with symptomatic moderate and severe aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular systolic dysfunction. Medical management of concurrent hypertension, atrial fibrillation, and coronary artery disease will lead to optimal outcomes.
Topics: Aortic Valve Stenosis; Echocardiography; Heart Valve Prosthesis; Humans; Severity of Illness Index
PubMed: 26926974
DOI: No ID Found -
JACC. Cardiovascular Interventions Jun 2021
Topics: Aortic Valve Stenosis; Heart Valve Prosthesis; Hemodynamics; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34112459
DOI: 10.1016/j.jcin.2021.04.024 -
Journal of Interventional Cardiology Jun 2018Degenerative aortic valve stenosis is the most common valvular heart disease seen in developed countries. Since the implementation of transcatheter aortic valve... (Review)
Review
Degenerative aortic valve stenosis is the most common valvular heart disease seen in developed countries. Since the implementation of transcatheter aortic valve replacement, there has been a surge of efforts to improve procedural technique as well as reduce mortality. Until recently, the mainstay method of assessment of valve implantation as well as paravalvular regurgitation has relied heavily on imaging techniques including transesophageal echocardiography and aortic root angiography. There has been a lot of scientific inquiry to identify biomarkers in the management of patients with aortic stenosis. von Willebrand factor activity and high molecular weight multimer level assessment has emerged as an excellent biomarker with intraoperative, point of care potential. These implications can both supplement imaging modalities as well as potentially serve as a more accurate assessment TAVR complications.
Topics: Aged, 80 and over; Aortic Valve Stenosis; Biomarkers; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Transcatheter Aortic Valve Replacement; von Willebrand Factor
PubMed: 29285810
DOI: 10.1111/joic.12478 -
JACC. Cardiovascular Imaging Feb 2020
Topics: Aortic Valve Stenosis; Fibrosis; Humans; Myocardium
PubMed: 31326482
DOI: 10.1016/j.jcmg.2019.05.021 -
The Journal of Thoracic and... Apr 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Simvastatin; Transcatheter Aortic Valve Replacement
PubMed: 31813536
DOI: 10.1016/j.jtcvs.2019.10.138 -
Journal of the American College of... Jun 2021
Topics: Aortic Valve Stenosis; Humans; Stroke Volume
PubMed: 34082910
DOI: 10.1016/j.jacc.2021.04.027 -
Journal of the American College of... Aug 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Severity of Illness Index; Stroke Volume; Ventricular Function, Left
PubMed: 35953134
DOI: 10.1016/j.jacc.2022.05.037 -
Circulation Research Apr 2021Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular... (Review)
Review
Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.
Topics: Age Factors; Animals; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Disease Progression; Humans; Medical Illustration; Mice; Risk Factors; Ventricular Outflow Obstruction
PubMed: 33914609
DOI: 10.1161/CIRCRESAHA.120.317978 -
Journal of the American College of... Dec 2020
Topics: Aortic Valve Stenosis; Crime; Diastole; Humans; Registries; Transcatheter Aortic Valve Replacement
PubMed: 33334423
DOI: 10.1016/j.jacc.2020.10.034